How Does Peer Review Impact My Nursing Practice

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A hallmark of professional practice, nursing peer review is the procedure past which practicing RNs systematically assess, monitor, and requite feedback to peers near the quality of nursing intendance measured against professional person standards of practice.¹ Nursing peer review supports self-regulation of clinical practice, personal empowerment, and a culture of accountability.^two The purpose of nursing peer review is to ensure that patient care is delivered according to clinical practice standards, achieving an optimal level of quality.³

Our health system consists of 9 hospitals ranging in size from a 25-bed critical admission hospital to a regional medical center with 450 beds. Information technology includes a behavioral health facility, as well as a Level 2 trauma middle. Historically, our organization utilized a peer review process of bearding feedback linked to almanac operation appraisals past the leader, likewise equally incident review by a committee. Afterwards studying the principles of nursing peer review, information technology was determined that a alter was needed. An initiative was launched to transform the organization'south nursing peer review process into real-time, face-to-face feedback given by a nursing peer to promote an environment of professionalism, autonomy, and accountability. Additionally, nurses' perceptions of peer review were measured via a survey before and afterward implementation of the new peer review process.

Background

Constructive peer review is indispensable for holding nursing practice to the highest standards. Peer review is the responsibleness of each nurse to maintain competence and contribute to personal and professional person growth.^three Although the American Nurses Association (ANA) published the initial guidelines for peer review in 1988, demonstration of a fully show-based peer review process however isn't evident in virtually institutions. Many continue to use anonymous feedback tied to functioning evaluation.^four-6 One descriptive study of peer review programs in Magnet^® hospitals identified variation in peer review practices, with only 2 consistent types of peer review: peer evaluation or performance review and evaluation of clinical practice in relation to specific events.^four The authors too institute that facilities didn't measure the impact of clinical peer review on perceptions, autonomy, and professional person practice, and concluded that more research is needed to define the impact of peer review.⁴

Another study suggested that the ultimate goal of peer evaluation is empowering nurses to hold each other accountable for high-quality care, which leads to an increase in autonomy, competency, and professional growth.⁷ Confront-to-face up nursing peer review offers existent-time feedback almost practise decisions; supports quality of nursing intendance through self-regulation; and fosters a civilization of learning, patient safety, and best practices.^8,9

When evaluating current nursing peer review practices or planning to implement nursing peer review into clinical practice, the evidence-based principles outlined by the ANA will help guide successful and consequent practices. The six exercise principles of nursing peer review are as follows:^viii

1. A peer is someone of the same rank.
2. Peer review is practice-focused.
3. Feedback is timely, routine, and a continuous expectation.
4. Peer review fosters a continuous learning civilisation of patient condom and best do.
5. Feedback isn't bearding.
6. Feedback incorporates the nurse's developmental stage.

Iii types

Three types of peer review take been identified by The Advisory Board: in-the-moment collaboration, just-in-time feedback, and holistic peer evaluation.¹⁰

In-the-moment collaboration occurs when nurses work together as partners in patient care delivery. This involves existent-fourth dimension feedback and cooperative discussions.

But-in-fourth dimension feedback is delivered immediately later an event and offers concrete, credible suggestions for responding to specific events.

Holistic peer evaluation is given at a set time and provides reflection on practice over time. This method identifies specific strengths and opportunities for farther development, including opportunities for professional growth and cocky-awareness. Holistic peer evaluation must occur face to face up at a designated fourth dimension and place. The manager isn't part of the peer meeting and doesn't receive details of the peer review unless shared by the nurse. The results aren't tied to almanac evaluation, but this blazon of peer review offers the nurse the opportunity to reflect on the feedback received and set goals for the coming yr related to his or her own professional evolution.

It'southward an expectation at our organization that in-the-moment collaboration and just-in-time feedback are routinely delivered. Nonetheless, it'due south hard to rails whether this occurs without direct observation or self-study. Therefore, the focus of the new peer review process is holistic peer evaluation that allows the nurses to gear up alee of time. Nurses apply the nursing competency evaluation tool to guide the conversation and can besides offering coaching or suggestions for improvement.

When giving and receiving feedback, the individuals demand to be aware of their personal biases and body linguistic communication. The person receiving the feedback should strive to kickoff understand where it'due south coming from: perceptions or interpretation of data. Information technology'due south important to e'er remember that feedback is provided to help with comeback of patient intendance and for professional person evolution.⁸

Methods

Understanding the importance and effectiveness of peer review to increase the professionalism of clinical nurses in a meaningful way, the chief nursing executive, along with several clinical nurses, attended presentations regarding peer review at a national conference. From these presentations, the clinical nurses were inspired to pursue a comprehensive confront-to-face peer review process. The journey began with a airplane pilot on an inpatient medical-surgical unit. Using the Academy of Medical-Surgical Nurses' Telescopic and Standards of Medical-Surgical Nursing Practice and best practices from The Advisory Board, a form was created to be used every bit a guide for the comprehensive peer review process.^10,eleven Nurses were randomly paired according to shift, and the pairs met for a contiguous meeting to discuss strengths and growth opportunities. Pedagogy was completed using several formats, including a staff-designed video demonstration. After a successful pilot, the process was implemented for all of nursing beyond the nine-hospital health system.

The arrangement-wide procedure was implemented starting with the germination of a committee. The pilot process was reviewed and an educational development programme, including 2 hours of didactic curriculum, was created, along with an electronic nursing peer review tool. Separate tools were developed based on the various professional practise standards for each nursing specialty. The forms are completed online and housed in a secure electronic library with access limited to but a human resources department designee and the chief nursing executive.

Besides the extensive educational classes, additional opportunities were offered for nurses to practice giving feedback. For leaders, railroad train the trainer sessions were provided focusing on how to support nurses through this change. During the first twelvemonth of the new peer review process, nearly 2,400 nurses participated in face-to-face peer review.

As function of the implementation plan, clinical nurses' perceptions of the new peer review process were measured before implementation. A survey was conducted before educational activity and implementation, and repeated later the first peer review menstruum. This research was approved through the Institutional Review Board as an expedited study with modified informed consent every bit the beginning question of the survey. The survey used was the George/Haag-Heitman Clinical Nurses Perceptions of Peer Review survey tool, developed using the components of the George/Haag-Heitman conceptual model.^two,12 The survey consists of 26 forced-pick questions to indicate the degree of agreement on a Likert scale of 1 to 7. Ii additional open-concluded questions target barriers and other insights into peer review practice. The demographic data collected included historic period-group, ethnicity, nursing education, years of nursing feel, and current expanse of nursing. The researchers engaged with two external experts to review the open up-ended questions for common themes reported by respondents using open up coding analysis and abiding comparative analysis. Then the researchers collectively compared the concepts, developed higher-society abstract categories, and integrated them into core themes.

Results

Before implementation, 560 (23% response charge per unit) clinical nurses completed the survey; 310 (13% response charge per unit) nurses completed the post survey. The only demographic difference betwixt the 2 groups was in number of years at their current hospital; all other demographic variables weren't significantly different. The demographic results are presented in Table 1.

Table 1::

Demographics

Most of the questions relating straight to the peer review procedure had a pregnant change after the peer-to-peer feedback sessions were completed. There was a significant difference in nurses' perceptions related to giving and receiving feedback (P = .000). Nurses as well felt they could make a modify in practice based on discussion with their peers after the peer review process (P = .006). Nurses' perception of autonomy too increased after the procedure (P = .052). Survey results are presented in Table 2.

Table two::

Survey question results

3 questions were added to the 2d survey to assess how prepared the nurses felt in the peer review process. The responses to these questions are listed in Tabular array 3. Overall nurses felt supported in the peer review process and took fourth dimension to prepare for the survey.

Table 3::

Process-related questions

Discussion

Although there are all the same barriers and some nurses aren't comfortable with the procedure, implementing a face-to-face peer review process has been an overall positive experience. Nurses who felt they could make a change in practice based on discussion with their peers after the peer review process increased from 71.8% to 81.1%. Some other positive aspect was that nurses' perception of autonomy increased after the process, although this didn't reach statistical significance.

Nurses' perceptions before and later on implementation changed significantly in most areas related to the peer review processes. More nurses stated that they were comfy receiving feedback from their peers subsequently implementation of the process (77%); however, at that place was still a percentage of nurses who weren't comfortable giving feedback (23%). This indicates further opportunity for training and skill evolution. The question "the quality of the information I receive from my peers is valuable to my professional development" wasn't statistically changed (P = .430), which may stand for another opportunity to focus on the content of the peer feedback received to make it more than meaningful. Although giving anonymous feedback was perceived as a safer environment, the new contiguous process allows for more professional development, fosters a collegial relationship amongst nurses, and builds teamwork and communication skills.

The main limitation of this study was the depression response charge per unit on the second survey. The surveys were blinded, and then we weren't able to friction match them or make up one's mind which areas responded.

To better understand nurses' perceptions of peer review, a qualitative research written report is currently being undertaken. The goal of the written report is to highlight areas of further education and enrich the experience for all nurses as nosotros progress from novice to expert within the process.

Implications for practice

A potent nursing peer review program is a professional obligation that increases accountability and professionalism. When nursing peer review focuses on show-based practice standards, optimal patient outcomes can be accomplished.

REFERENCES

1. American Nurses Association. Peer Review Guidelines. Kansas City, MO: American Nurses Association; 1988.

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2. George Five, Haag-Heitman B. Peer review in nursing: essential components of a model supporting safe and quality. J Nurs Adm. 2015;45(7–viii):398–403.

3. George V, Haag-Heitman B. Nursing peer review: the manager'due south role. J Nurs Manag. 2011;nineteen(2):254–259.

four. Roberts H, Cronin SN. A descriptive study of nursing peer-review programs in US Magnet^® hospitals. J Nurs Adm. 2017;47(four):226–231.

5. Davis KK, Capozzoli J, Parks J. Implementing peer review: guidelines for managers and staff. Nurs Adm Q. 2009;33(3):251–257.

6. Garner JK. Implementation of a nursing peer-review plan in the hospital setting. Clin Nurse Spec. 2015;29(v):271–275.

7. Burchett ML, Spivak M. Nurse peer evaluation: a roadmap to professional growth and development. Nurs Manage. 2014;45(8):18–20.

8. Haag-Heitman B, George V. Nursing peer review: principles and practice. Am Nurse Today. 2011;6(9):48–52.

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nine. Semper J, Halvorson B, Hersh Chiliad, Torres C, Lillington L. Clinical nurse specialists guide staff nurses to promote practice accountability through peer review. Clin Nurse Spec. 2016;xxx(1):nineteen–27.

ten. The Advisory Lath Visitor. Building Peer Accountability: Toolkit for Improving Advice and Collaboration. Washington, DC: The Informational Lath Visitor; 2011.

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eleven. Academy of Medical-Surgical Nurses. Telescopic and Standards of Medical-Surgical Nursing Practice. 5th ed. Pitman, NJ: Academy of Medical-Surgical Nurses; 2012.

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12. Haag-Heitman B, George 5. Peer Review in Nursing: Principles for Successful Practice. Sudbury, MA: Jones and Bartlett; 2011.

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