Dear Evil HR Lady,

 I am a nurse anesthetist and have been employed with a small anesthesia group for one year. The anesthesia office manager and the head anesthesiologists gave me my one year review. In the review it was commented that I performed below my peers for intubation. When asked for specific examples they were unable to give me any. I asked if there had been a bad outcome for a patient as a result of my intubation. They responded no. All I could think to say at the time was that I believe that I have good intubation skills however would be glad to write down anytime I was unable to get an intubation. Perhaps my perception was wrong.

We then moved onto regional skills. The group hired me knowing I had little to no regional experience and they were fine with that. After my six month review they changed their mind and decided that I needed regional skills. I responded by attending a 3 day seminar held by my professional association. I have since been trying to gain regional experience at work, but have had little opportunity. Our practice is small and we don’t do regionals frequently. On my one year review they stated that they were very concerned that I had not been able to master regional techniques. Again I have fallen bellow my peers.

 Prior to this job I had been employed for 8 years and always had wonderful reviews. I am at a loss as to know what to do. I have thought of meeting monthly with them to review specifics incidences that involve my practice that has them concerned. Do you have any thoughts?

Well, I know nothing about anesthesia other than epidurals are a sign that God loves me, so these answers will be general. But first a question: Who was the best president during your lifetime?

Have an answer?

Good. Now sit down and write a list of 25 things that he did that you liked. Too many? Try 10. Still too many? Probably. Just because you can’t come up with examples on the spot doesn’t mean that your favorite president wasn’t awesome, and that you couldn’t find 25 things if you had a bit of time to peruse his Wikipedia page. Humans often don’t retain the exact information, but rather simply add a negative or positive mark towards a person or incident or thing. That means that sometimes when you say, “Well, I loved President Palmer the best!” you can feel somewhat stupid when someone inquires further, “What did he do that was so awesome?” Our brains remember the awesome (or negative) feelings and creates an overall picture, but we don’t know the details.

That as a really, really, long way to say, you may have some problems. Just because they can’t immediately identify them, doesn’t mean they don’t exist. (Although, to be honest, if you’re going to give someone a negative performance review, you should have a list of the things they did wrong sitting in front of you, because otherwise it looks like you’re just being negative.) So, you need to consider the possibility that you aren’t as good as your peers at intubation.

Additionally, since you know you’re not as good at regionals as your coworkers, you know you have some work to do. You don’t want to lose this job, but the reality is, they probably don’t want to lose you either, since recruiting and training is a pain in the patootie. So, ask directly, “I’d like to improve my skills at intubation and regionals. What can I do to make sure that happens?”

Then listen to their responses. And do what they say, even if you think they are absolutely nuts and you could teach classes in intubation. Because, even if you are perfect, the perception is that you are not. It could be that you do it differently than they do, which their brains interpret as “worse.” So, be willing to listen and learn. Also ask them to point out, directly after, if they see something. Volunteer to do all the regionals in order to improve your skills. Ask if you can observe your coworkers. Take a seminar again if you can.

The point is to demonstrate that you are taking them seriously, even if they are off their rockers. (Sometimes people just don’t adjust well to new coworkers, and sometimes there are personality clashes and sometimes work can be like re-entering junior high school.)

And, while you’re at it, document what you’re doing, and comments that coworkers, patients, doctors and nurses say about your skills.

Chances are, if you show willingness to learn from your coworkers you’ll be graded higher, even if your skills were good to begin with. But on the off chance that they aren’t, learning from them will also help you to perform at a higher level.

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10 thoughts on “My Yearly Review Is Wrong

  1. I know this isn’t germane to the post, but I think it’s great that you’re posting every day. I really enjoy your website.

    1. Thanks! I set a goal to put posts up every week day. So far, so good!

      Also, since CBS killed the dear EHRL format, I’ve been doing that here, and I like it better.

  2. “Even if you are perfect, the perception is you’re not.” I think your answer here is way off base. You’re giving advice for normal jobs and this is not a normal job. These are peoples’ lives. If she is doing her intubations correctly then she shouldn’t change. Trying to change to someone else’s technique could cause her to fail more and hurt people.

    I don’t know what the regionals thing means and it sounds like something she could work on.

    I think you could have at least mentioned her boss could just be a jerk. Maybe he dings everyone on their first review so they can “improve” later. Maybe he had no money for a raise so she got a bad review to justify it. Maybe she doesn’t bring donuts enough.

    I also really disagree about examples/details. Anyone who says you’re doing badly on a really important part of the job should have something to tell you. Not just “you’re worse”. You’re slower, you don’t clean up, Patient A had trouble. It is a manager’s responsibility to have these details. If as a manager you can’t remember then write things down.

    1. “It is a manager’s responsibility to have these details. If as a manager you can’t remember then write things down.”

      Absolutely. And mention them _at the time they occur_. Don’t wait until the annual review and then say “Oh, you’re not at the same level as your peers”.

      An annual review isn’t a personality contest. If you can’t prove something, it did not happen. If you can only give vague comments, you’re a bad manager.

    2. I said at the beginning that i know nothing about anesthesia so the answer would be general. But, even knowing nothing, I doubt that there isn’t a range of skill in intubation. I doubt it’s a 2+2=4 situation and some people can be better than others at it.

      Her boss could be a jerk, but if you take every criticism from your boss as “he’s a jerk!” then you will miss out on any opportunity to get better at what you do.

      1. Absolutely! So managers don’t do. Many don’t even say anything at formal reviews–or even hold formal reviews. They just silently steam about problem employees.

  3. Oh the stories I can tell from my time as a State Government employee. Or now as a private employee.

    Color me as another person who feels the supervisor has a responsibility to keep details of when things are not right and to bring them up quickly (and professionally, not in front of everyone) when things happen.

    Waiting until the annual review is always the wrong time to do this.

    We just went through this exercise at work and a new co-worker celebrated his 1 year anniversary with an official plaque and a Performance Improvement Plan. That was October 2013 and by January 2014 this person was gone.

    Sadly this person was hired without the needed skills and was unable to acquire them.

    The OP though came in with skills and experience. Per the OP, there were no negative impacts meaning her technique was good enough to intubinate the patient correctly. My wife has had enough surgeries through the years I know good and bad outcomes.

    No, vague complaints and accusations have no or little place at annual reviews. Any items ticked should have specific details. Otherwise lawsuits happen and one of HR’s function is to help prevent or lessen lawsuits because jerks want to make false or unfounded accusations.

    Sure, the OP should take in to consideration there could be some foundation for the remarks. Reflect on what was said, review the notes from all the procedures and see if anything was missed or overlooked. Look to see if all policies and procedures for intubation were followed and followed correctly.

    Sadly I think the advice given has fallen short. A comparison between a favorite president, ball player, etc is a far cry from someone on the receiving end of a annual performance review.

    IOW, I find your response lacking and feel you need to improve.

  4. You can probably improve your intubation skills but that won’t help you. Why? You have managers that that thought it was reasonable to spring this on you at an annual review. They are incompetent managers.

    Start looking for another job immediately. They won’t change. Next year they will spring something else on you. Don’t let them destroy your self confidence by making you worry for another year.

    1. Many managers think that they should *only* give feedback at a performance review.

      Sad, but true.

  5. Late to the game but I figure I’d jump in anyway…

    I used to be a paramedic and I intubated so I have some knowledge here. While there are slight variations in technique, outcomes are VERY easily measured. Someone can complain that the tube wasn’t tied on the correct side of the patient or other such superficial things but the reality is that a blood oxygen is monitored as well as other vital signs to ensure the patient is as stable as possible. If the not breaking/cracking teeth, causing stomach distension or other physical issues, this manager is being picky. Yes, there’s more to it but that’s the general idea.

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