Nurse Peer Review

Peer review learning module

Facilitated by: Karla Cifuentes MSN-ED,RN

Nursing peer review is a process in which a nurse of equivalent rank evaluates, monitors, and assesses the quality of care provided by other Registered Nurses following professional standards of care and practice.

(Foster 2015)

Peer Review

Nursing Excellence

Peer review and peer evaluation are at the core of exemplary professional practice, 1 of the 5 pillars of the American Nursing Credentialing Center (ANCC) Magnet® recognition program for nursing excellence.

• Implementing a Nurse Peer Review Program aims to enhance the quality of care and promote professional growth among nurses.

• This program aims to provide a structure for ongoing evaluation and feedback, elevating accountability and empowering nurses to improve their practice continually.

(Relias, 2021)

LEARNING OUTCOMES

By the end of this training module, nurses will be able to:

• Articulate the role of peer review in promoting accountability, professional development, and quality patient care.
• Explain how peer review contributes to continuous improvement within the nursing profession.
• Demonstrate effective techniques for providing constructive feedback that fosters growth and improvement.
• Identify strategies for receiving feedback with an open and reflective mindset.
• Utilize evidence-based criteria and standards to assess peer performance in clinical care, decision-making, communication, and professionalism.
• Recognize how peer review fosters a culture of collaboration and shared responsibility among nursing staff.
• Use peer review insights to guide ongoing professional learning and clinical skill enhancement.

Objectives

Feedback is related to the individual’s stage of professional development.

Feedback is not anonymous.

Promotes a culture of patient safety, best practices, and lifelong learning.

Feedback needs to be timely, made part of an ongoing routine.

A peer review is focused on clinical practice.

A peer is someone of the same rank.

Principles for Contemporary Peer Review Practice

Based on the ANA peer review guidelines (Haag-Heitman & George, 2011)

Peer review must be conducted by nurses with similar roles and specialties: direct care nurses may only review peers with matching responsibilities, units, and shifts, while nurse managers can only review other managers.

In the context of learning, feedback may be perceived as something positive as opposed to this feedback being incorporated into the annual employee evaluation (relias, 2021)

Peer review is different from peer evaluation

• Peer review is not voluntary, as all nurses across the Magnet® organization need to participate (Foster, 2015).
• Involvement in a peer review process aims to (Bowen-Brady et al., 2019):
• Increase accountability
• Encourage autonomy
• Improve patient quality outcomes
• Enhance professional practice

Peer evaluation is usually incorporated in the periodic performance appraisal of a nurse, it may impact opportunities for career growth and advancement, and it is voluntary.

(Relias, 2021)

Healthy Work Environment

• Nursing job satisfaction and improved patient outcomes are intrinsically related to the work environment.
• Communicating effectively fosters an environment of peer accountability, mutual respect, and teamwork.
• Guided questions may help nurses reflect on their practice:
• If I make an error, I feel supported to learn and grow from it.
• My supervisor makes a meaningful contribution to my performance evaluation to help me grow professionally.
• Beyond the performance evaluation, I receive feedback often.
• I am aware of the areas I need to improve.
• I am comfortable giving and receiving feedback to a peer.
• I feel that I have autonomy in my practice.

Barriers to the Peer Review Process

• Perception that peer assessment is biased • Fear of retaliation or lateral violence • Unsuitability for overall performance evaluations • Lack of reflection on actual clinical practice • Nurses may not understand the purpose or value of peer review • Feedback can trigger insecurities, self-doubt, feelings of failure, and anxiety • Belief that peer review is not part of the nursing role • Discomfort with providing feedback IMPROVING PERCEPTIONS • Allow time for nurses to understand the purpose and positive impact of peer review • Standardize and structure the feedback process, clarifying roles and expectations

(Relias, 2021)

giving & receiving feedback

Giving Feedback

These are common behaviors that negatively affect the peer review process

• Failing to provide specific examples
• Being unprepared
• Providing negative feedback in a public area
• Untimely feedback
• Waiting too long before providing feedback for an action that requires prompt intervention
• Poorly scheduled, unplanned peer review session
• Discussing the opinions of others rather than observed behavior
• Focusing on all the negatives
• Compliment without offering specific examples
• Canceling last minute, avoiding face-to-face discussion

(Relias, 2021)

For feedback to be effective

• Be clear and focused regarding the topic you need to discuss

• Reflect genuine empathy
• Be as descriptive and concrete when discussing observed problematic behavior, give examples
• Indicate impact of behavior
• Frame feedback in terms of patient outcomes and evidence-based practice.
• Make suggestions or recommendations based on the established process
• Avoid statements that focus on personal traits.

(Relias, 2021)

Recieving Feedback

• Feedback on Performance:

• Often evokes an emotional response for both the giver and the receiver.
• May not always be perceived as a positive experience.
• Developing a Positive Approach to Feedback:
• Requires education and practice to view feedback as a transformational tool.
• Involves learning to welcome feedback for continuous improvement.
• Professional Growth and Accountability:
• Depend on self-awareness and the ability to receive and act on feedback.
• Assume the intent is positive
• Do not get defensive.
• Get more information, seek clarification.
• Do not isolate; use this opportunity to reboot relationships with peers.

(Relias, 2021)

Reflection Exercise: Think about a time when feedback helped you improve your practice. How did it influence your work?

Peer Review Committee

Click me

Committee Membership may include representatives from:

• Management
• Education
• Performance Improvement
• Direct Care Nursing
• Participation of direct care nurses in a peer review committee empowers nurses to speak up about system issues that affect the nursing provision of care (Haag-Heitman & George, 2011).

Nursing Peer Review Committee Bylaws should include:

• Code of Conduct
• Confidentiality Guidelines
• Member Representation Requirements
• Determine root causes and provide recommendations for individual referral

(Relias, 2021)

The peer review process enhances patient care outcomes by promoting a supportive environment of shared learning and knowledge exchange.

By clearly outlining the expectations of the nursing roles, peer review programs reduce ambiguity and enhance consistency in patient care, maintaining high standards within the healthcare setting.

Improved nursing competencies and adherence to best practices and evidence-based care led to higher quality care, reduced errors, and better patient satisfaction (Roberts & Nones Cronin, 2017).

IMPLICATIONS

THANK YOU!

• Bowen-Brady, H., Haag-Heitman, B., Hunt, V., & Oot-Hayes, M. (2019). Asking for Feedback: Clinical Nurses’ Perceptions of a Peer Review Program in a Community Hospital. JONA: The Journal of Nursing Administration, 49(1), 35–41. https://doi-org.northernkentuckyuniversity.idm.oclc.org/10.1097/NNA.0000000000000705
• Foster, R. R. (2015). Distinguishing the difference between peer review, peer evaluation, and peer feedback. American Nurses Association. https://www.nursingworld.org/organizational-programs/ana-consultation-services/tips-articles-and-videos/distinguishing-the-difference-between-peer-review-peer-evaluation-and-peer-feedback/
• Haag-Heitman, B., & George, V. (2011). Nursing peer review: Principles and practice. American Nurse Today. https://www.myamericannurse.com/nursing-peer-review-principles-and-practice/
• Relias LLC. (2021). Excellence series: Performance and peer evaluations. Relias.
• Roberts, H., & Nones Cronin, S. (2017). A descriptive study of nursing peer-review programs in US Magnet® hospitals. Journal of Nursing Administration, 47(4), 226-231. https://doi.org/10.1097/NNA.0000000000000469

References

The secret to giving good feedback