Do nurse performance appraisals reflect caring behaviors? Evidence from an Indonesian hospital

Introduction Nurses' caring behavior is central to the quality and humanistic orientation of nursing services. However, many hospital performance appraisals remain task-oriented and may insufficiently reflect caring competencies essential to patient-centered care. This study examined the association between nurses' caring behavior and Individual Performance Index (IPI) scores and identified caring dimensions requiring improvement. Methods A cross-sectional study was conducted among 228 nurses in a public hospital in Jakarta, Indonesia, recruited through simple random sampling. Caring behavior was measured using the Caring Behavior Inventory (CBI-42), and IPI was self-entered by nurses based on their most recent official monthly appraisal report. Spearman's rank correlation was used (two-tailed, α = 0.05). Results No significant association was found between overall caring behavior and IPI scores ( r = 0.027; p = 0.680), although both measures were generally high (median CBI = 3.50 2.00–4.00; median IPI = 1.00 0.80–1.10). Positive connectedness (3.44) and attentiveness to others' experiences (3.50) were comparatively lower than the other caring dimensions. Discussion Current appraisal systems may not adequately capture caring competencies. Integrating explicit caring indicators into nurse performance evaluation may strengthen workforce development and support patient-centered health systems. Conclusion Nurse performance appraisal scores were not significantly associated with caring behavior, suggesting that existing appraisal systems may not adequately reflect caring competencies in nursing practice. Incorporating explicit caring-related indicators into performance evaluation may improve the alignment between assessed performance and the humanistic goals of nursing care.