Nurses’ Professional Performance: The Development and Evaluation of a Formative Workplace-Based Self-Assessment Instrument

Background Workplace-based performance assessment and feedback are essential for nurses’ development, helping to close the gap between their expertise and the requirements of their job roles and guiding the development of their expertise. Mismatches can lead to challenges, including lower-quality care, reduced job satisfaction, work stress, burnout, and early job turnover. In this study, a formative workplace-based performance assessment is developed to address this gap. Aim To develop and evaluate a workplace-based, development-oriented performance assessment instrument concerning nurses’ professional tasks from beginner to expert levels. Design Instrument construction followed an iterative design based on the Evidence-Centered Design (ECD) Model of Mislevy (2012). This approach addressed the ‘Eight Validity Challenges’ outlined by Mislevy (2016) related to the design, modeling, scoring, and scale development of nurses’ professional performance. Methods The Formative Assessment for Nurses' Professional Performance (FAN) instrument was developed in the Netherlands using the Evidence-Centered Design Model and ‘Eight Validity Challenges’. Initial indicators were derived from participation, observation, literature searches, and analysis of nurses’ tasks. Several independent, experienced professionals reviewed the content and provided feedback. During development, multiple analyses were conducted to assess reliability and validity, including Exploratory Factor Analysis, reliability analysis, Item Content Validity, Pearson’s correlation, Generalized Partial Credit Model, Confirmatory Factor Analysis, independent-samples t-tests, ANOVA, and paired-samples t-tests. Results The Formative Assessment for Nurses' Professional Performance instrument, developed using the Evidence-Centered Design Model, comprises three job domains, 21 subscales, and 93 items that span the broad scope of nurses’ work. It assesses nurses’ professional performance tasks from beginner to expert levels and identifies their development needs. The instrument was completed by 5,411 nurses across various roles and workplace settings in 22 hospitals and two rehabilitation centers in the Netherlands. It consistently demonstrated confirmatory factor loadings above .50, Cronbach’s alpha coefficients above .70, and discrimination coefficients above 1.0. Expected differences by educational level, job role, and workplace setting were tested statistically. All ‘Eight Validity Challenges’ for educational assessment development were integrated. Conclusion This study provides strong evidence for the validity, reliability, and feasibility of the Formative Assessment for Nurses' Professional Performance among nurses across different educational levels, job roles, and workplace settings across a variety of hospitals and rehabilitation centers in the Netherlands. The workplace-based self-assessment measures nurses’ professional performance, identifies gaps, and supports professional development and workforce reform at both the team and organizational levels. It also provides direction for aligning organizational goals with nurses' goals.