RATINGS OF THE PERFORMANCES OF PRACTICING INTERNISTS BY HOSPITAL-BASED REGISTERED NURSES

Purpose. To examine the feasibility and reliability of ratings complet ed by hospital-based registered nurses of the humanistic qualities, co mmunication skills, and selected aspects of the clinical skills of pra cticing internists. Method. In 1988-1989, registered nurses who worked in the same 175 hospitals as 232 internists with admitting privileges at these hospitals rated the internists' performances. The nurses wer e selected from medicine floors, specialty floors, and intensive care units and/or critical care units, using lists provided by head nurses. A total of 1,877 rating questionnaires with 13 performance categories were collected (with a mean of 8.01 nurses per internist). The rating s were analyzed to determine measurement characteristics and the relat ionships of the nurses' demographic characteristics to the ratings. In addition, for each of ten performance categories for 152 of the inter nists, the average rating each internist received from nurses was comp ared with the average rating each internist received from peer physici ans. Statistical analysis used Pearson correlations, canonical correla tions, factor analyses, Student's t-tests, analysis of variance, and s tepwise multiple regression. Finally, the internists themselves, inclu ding physicians who were not actually rated by the nurses, were asked to complete a brief questionnaire that included questions about their opinions of the use of nurses' ratings. Results. The nurses' ratings c orrelated moderately strongly with the peer physicians' ratings and ha d a common structure. However, the nurses' ratings were lower for seve ral humanistic qualities, including respect, integrity, and responsibi lity, and their ratings were higher for medical knowledge and verbal c ommunication. Across the 13 performance categories, approximately 10-1 5 ratings from nurses were needed to obtain a reliable assessment of a n internist's humanistic qualities and communication skills. Many inte rnists felt that nurses' ratings should be used equally with, or at le ast as a lesser contribution to, ratings by peer physicians of humanis tic qualities and communication skills. Conclusion. Nurses' ratings ap pear to provide a feasible and reliable method of evaluating the inter nists' communication skills and humanistic qualities, when used in con junction with ratings by peer physicians.