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Dr. Foster now works full time as a consultant and educator. She is based in California and serves clients around the world. During her tenure as chief nursing officer of the St. Joseph Health System of Sonoma County, Dr. Foster was considered an empathetic advocate and was lauded for her ability to inspire and motivate others toward a common vision. Understanding the benefits of technological advances in Health care administration, Dr. Foster, a catalyst and early adopter, led the implementation of an electronic medical record system that provided computerized physician order entry and ease in nursing documentation and medication administration. In addition, prior to its becoming a widely accepted practice, Dr. Foster implemented a nurse residency program for new graduate nurses that resulted in a 40 reduction in turnover. Dr. Foster has a master of science degree from Georgetown University, a master in public health degree from the Northwest Ohio Consortium, and a doctorate of education in leadership studies from Bowling Green State University. It is the mechanism used to: In addition to considering the rank of the nurse and nursing practice, it is intended to take into account the developmental stage of the nurse, to foster a continuous learning culture of patient safety and best practice, and to provide feedback that is continuous, timely, and routine. Peer evaluation is always completed by a peer; but if it is done as a part of a 360-degree process, all members of the contributing team (some may or may not be peers) should complete the evaluation. Peer evaluation is voluntary; peer review is not. Conducting 360-degree evaluations is an option for the organization; peer review is NOT optional for a professional. 4 The peer feedback tool is the tool used by peers to evaluate their peer’s performance against specific organizational standards, goals, and objectives.

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It is designed to provide input based on observed performance and enables the receiver to have an understanding about personal and professional strengths and gaps in practice or performance.Nurses are responsible for both peer and self-assessments, and must strive for excellence in their nursing practice, whatever the role or setting. The Foundation does not engage in political campaign activities or communications. This article defines and describes a set of principled peer-review guidelines for nurses based on ANA standards. Managers aren’t peers with direct-care nurses, even though managers have practiced as direct-care nurses. Peer groups include direct-care nurse to direct-care nurse, advanced practice nurse (APN) to APN, educator to educator, manager to manager, director to director, and nursing administrator to nursing administrator. Effective peer review incorporates evidence-based nursing practice and quality and safety standards, with a focus on outcomes. To achieve continuous quality outcomes, organizations must create structures and processes that support dynamic feedback loops at all levels, starting at the point of care. Nurses also need new peer-review processes that move beyond traditional static processes (such as audits) to continuous and “just-in-time” models. A continuous learning culture shifts the focus from individual learning to organizational learning and fosters a common commitment to achieving and sustaining desired quality and safety outcomes. Direct-care nurses in a continuous learning culture frequently question the effectiveness of nursing practice. As a result, more timely modifications can be made to advance and update practice, along with the unlearning of ineffective or unsafe processes. Timely and continuous peer review provides the means for an effective systems-centered approach to error reduction.

According to the ANA Code of Ethics, the nurse has a duty to use respectful communication with an open exchange of views to preserve practice integrity and safety. Anonymous feedback lacks empirical support in promoting professional growth and patient safety. Participating in peer review can promote professional growth when the nurse’s developmental level is considered. Using a shared governance framework with staff-nurse leadership promotes ownership and accountability for outcomes within the peer group and can yield creative solutions to long-standing issues. The following example illustrates the design and implementation of a point-of-care peer-review process to address a familiar quality challenge, using the principles described above. When improvement is needed on a unit-specific outcome, the unit-based nursing quality council (UBNQC) reviews, communicates, and takes action. After examining the current pressure-ulcer prevention nursing care protocol and related education and competency assessment verification, the UBNQC concluded the protocol was up-to-date and related staff education and competency assessment had been completed. But a subsequent chart audit by the UBNQC found inconsistencies in documentation on the protocol intervention record, which is based on the Braden scale. Council members found that the relationship between the Braden scale score and determination of a patient’s pressure-ulcer risk wasn’t always clear; thus, the protocol wasn’t always individualized to the patient. Also, some nurses were still using nonapproved interventions, such as donut rings and massage. Before implementation, staff education was provided on the protocol, related nursing-care expectations, and the peer-review process. Expectations included a face-to-face handoff at the bedside; use of the pressure-ulcer prevention monitoring sheet; and correction of care deficiencies, alterations from the protocol, or unimplemented interventions found during handoff.

The peer-review process was designed to occur daily for 30 days. The tool was returned to the UBNQC for peer review—not to the manager, supervisor, clinical nurse specialist, or educator. All council members reviewed results from the monitoring period at their monthly meeting to identify trends and issues that needed additional attention and to decide if shift-to-shift monitoring should continue. Overall effectiveness of this focused peer review was reflected in periodic reports from the wound-care team rounds and quarterly pressure-ulcer prevalence data. Direct-care nurses created and monitored the process using shared governance processes—a real-time peer-to-peer practice review. Criteria focused on national evidence-based nursing standards. All direct-care nurses were expected to participate in assuring adherence to the pressure-ulcer prevention protocol during each scheduled handoff. Nurses were jointly responsible for identifying and correcting deviations from the protocol and completing the monitoring sheet during face-to-face interactions. This project involved collaboration between two nursing councils, focusing on evidence-based practice and quality data in creating a monitoring process and tool and subsequent education on the protocol. Frequent discussions of the protocol during handoffs provided opportunities for continuous learning and engagement on pressure-ulcer prevention. Peer-to-peer feedback was done face-to-face at the time of handoffs and gave nurses a chance to give and receive feedback. Face-to-face handoffs gave less experienced nurses the chance to interact with and be mentored by experienced nurses and gain knowledge and insight into pressure-ulcer prevention. Peer review helps address the boundaries of duty and loyalty for all nurses, including “the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth.” Peer Review Guidelines. Kansas City, MO: ANA; 1988.

The Magnet Model Components and Sources of Evidence. Silver Spring, MD: ANCC; 2009. New York Times. November 24, 2010.. Accessed August 4, 2011. Silver Spring, MD: American Nurses Credentialing Center; 2010. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: National Academies Press; 2010. N Engl J Med. 2010;363(22):2124-2134. Recovery from medical errors: the critical care nursing safety net. Jt Comm J Qual Patient Saf. 2006;32(2);63-72. Vicki George is president and chief executive officer of VMG Consulting in Plainfield, New Hampshire. Takeaways:Takeaways:Takeaways:Every week, you’ll get breaking news features, exclusive investigative stories, short news summaries, and more — delivered to your inbox. Sign up today to start your free subscription to NurseLine. Demonstration of an evidence-based nursing peer review process (NPR) is not evident in most institutions despite publication of the American Nurses Association (ANA) peer review guidelines in 1988. The American Nurses Associations identifies a peer as someone of the same rank, and peer review is practice-focused, feedback is timely, routine, and a continuous expectation. Peer review fosters a continuous learning culture of patient safety and best practice, feedback is not anonymous and incorporates the nurse’s developmental stage (1988). Prevalent in the literature are numerous positive outcomes associated with nursing peer review. Utilizing a nursing peer review process allows nurses to take ownership of the profession and improve the quality of nursing performance by identifying safety concerns and evidenced based solutions (Grootendorst, 2015). Nursing peer review is a professional obligation that increases accountability and professionalism. Optimal patient outcomes are achieved when the process focuses on evidence-based practice standards. Nurses feel they can make a practice change and have an increased perception of autonomy as result of participating in a nursing peer review.

Improved perceptions related to giving and receiving feedback were also identified (Murphy et al, 2015). Peer review allows nursing to demonstrate professionalism, accountability and autonomy to remain a trusted profession and lead to improved quality of nursing practice by allowing for trending of nursing gaps. Opportunities are provided to improve charting, patient advocacy, clinical skills, competency validation and staffing (Garner, 2015). With limited literature, a handful of challenges of nursing peer review identified include: maintaining consistency in peer representation on a review committee, standardized indicators to trigger a referral and standardized implementation of a structured screening process (Garner, 2015). A peer review process utilized in a shared governance model allows nurses to self-regulate and assess quality of nursing care. Garner utilized a borrowed shared governance model made up of a coordinating council with expertise in practice, education, research, leadership and quality. Mixed representation of committee members is selected according to organizational values such as: integrity, compassion, accountability, responsibility, intradisciplinary collaboration and ability to identify with individual perspective (2015). Standardized indicators to send a case to nurse peer review are not prevalent in the literature however, may be reflected by the organizational values or selected from the National Database of Nursing Quality Indicators (NDNQI). Garner selected the following indicators: falls with moderate or serious injury, major medication errors and patient significant events resulting in harm as defined by organizational quality safety standards, and poor handoff communication (2015). Another challenge of peer review is lack of a standardized referral process for reviews. In short, Garner depicts a borrowed nursing peer review process as follows. Referrals are made to a coordinator to review for criteria.

If criteria are not met, recommendations may or not be necessary, and sent directly back to the referral source. If criteria are met, the case is assigned to an individual reviewer, the nurse involved is notified, and data is summarized to present to the committee for discussion. If a response is required, the nurse and unit leadership are notified. Once all information is obtained the committee may agree on various outcomes. These include: exemplary practice identified with nurse recognition, letter to the nurse and leadership sent with no response required, a letter to the nurse and leadership with action plan and response required, or referral to the appropriate committee with a response required. A referral is then closed, summarized and reported to the nursing quality council, tracked by event and unit, and trended for process improvement (2015). To conclude, the literature shows a need and positive outcomes of implementing a nursing peer review process, despite identified challenges. The local organization intends to implement a nursing peer review process utilizing these findings. In summary, an evidence-based nursing peer review process improves peer accountability and identifies opportunities to address quality of nursing care. A Senior Nurse Scientist at Cleveland Clinic shares the potential pitfalls and ways to avoid them. In 1988, the American Nurses Association (ANA) released peer review guidelines. There are many benefits of the peer review process; but peer reviews are not without peril. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services Policy Her assertions still hold true today. Gratuitous nastiness is not acceptable,” says Siedlecki. There are many articles devoted to the peer review process in publications such as the Journal of Nursing Education and online content provided by the ANA. Numerous organizations also offer continuing education courses on peer review.
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The final review should be completed by a nurse manager, director or other leader. The process provides a good opportunity to experience what it’s like to be peer reviewed and to review others,” she says. “It’s a big responsibility, but an opportunity to grow, too.” Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services Policy Get insights and perspectives on our blog for nurses. Two stated purposes are the demonstration of professionalism and clinical competency. The American Nurses Association (ANA) defines nursing peer-review as a process for evaluating the care provided by an individual according to accepted standards. Further, the ANA proposes that nurses with similar rank and clinical expertise should conduct these evaluations. Some local jurisdictions may also mandate that advanced practice nurses (APNs) review one another’s care. Therefore, APNs should become familiar with sources for evaluation criteria and tool formats for APN peer review. The advantages and limitations of the various formats and processes of peer review should also be considered. By continuing to use our website, you are agreeing to our privacy policy. Our client insight platform, ClientIQ, will help your team adopt the concept of Insight-Led Selling. ClientIQ quickly allows you to compare prospects to their peers to inform better sales strategies. ClientIQ equips your team with insights to communicate credible, compelling, custom tailored solutions. See how they are compensated to learn what drives their decisions. It's simple to analyze a company historically and against its peers and industry. Great value- a real game changer. - Client Executive, IBM. An acquisition can help expand both the top and bottom lines but also has risks. Explore ideas from 16 professionals from Forbes Business Development Council. Try your search again or got back to the homepage. CORGI HomePlan Ltd is registered in Scotland (Company No. SC358475).

Registered Office: 1 Masterton Park, South Castle Drive, Dunfermline, KY11 8NX. The insurance policy is underwritten by OVO Insurance Services Ltd, a firm authorised and regulated by the Guernsey Financial Services Commission under reference number 2570126. OVO Insurance Services Ltd is registered in the Bailiwick of Guernsey under the Companies (Guernsey) Law 2008 (Company No. 67013). Registered office: PO Box 155, Mill Court, La Charroterie, St Peter Port, Guernsey, GY1 4ET. CORGI HomePlan Ltd and OVO Insurance Services Ltd are part of OVO Group Ltd. There are two kinds of nursing peer review: The review includes whether external factors beyond the nurse’s control mayhave contributed to any deficiency in care by the nurse, and to report such findings to a patientsafety committee as applicable; or Safe harbor must be invoked prior to engaging in the conductor assignment for which nursing peer review is requested, and may be invoked at any timeduring the work period when the initial assignment changes. The committee includes an employee or agent of the committee, including an assistant, an investigator, an intervener, an attorney, and any other person who serves the committee in any capacity. The nursing peer review process is one of fact-finding, analysis, and study of events by nurses in a climate of collegial problem solving focused on obtaining all relevant information about an event. Nursing peer review conducted by any entity must comply with NPR Law and with applicable Board rules related to incident-based or safe harbor nursing peer review.Any person(s) with administrative authority for personnel decisions directly relating to the nurse may not attend the IBNPR hearing (the only exception is a person who is administratively responsible over the nurse being reviewed may appear before the NPRC to speak as a fact witness to the conduct being reviewed).

A CNO, nurse administrator, or other individual with administrative authority over the nurse, including the individual who requested the conduct or made the assignment for which the nurse under review invoked SHNPR, may only appear before the committee to speak as a fact witness. A member, agent, or employee of a nursing peer review committee or a participant in a proceeding before the committee may not disclose or be required to disclose a communication made to the committee or a record or proceeding of the committee. A person who attends a nursing peer review committee proceeding may not disclose or be required to discloseinformation acquired in connection with the proceeding or an opinion, recommendation, or evaluation of the committee or a committee member. A nursing peer review committee member and a person who provides information to the committee may not be questioned about testimony before the committee or an opinion formed as a result of the committee proceedings.Specific policies must be in place for using informal work groups. The timelines applicable to the NPRC remain the same with the informal workgroup.As the Board does not regulate practice settings, the Board does not have authority to prescribe every aspect of nursing peer review at the facility or employer level. Examples of issues that must be addressed in facility policies include (but are not limited to): Such organizations may have developed generic policies, forms, etc.What records should the nursing peer review committee chairperson send to the Board when subpoenaed by the Board to send all nursing peer review records related to the nurse under investigation? The Board encourages facilities and employers to consider a permanent method of archiving nursing peer review documents. There is no statute of limitations on when nursing violations can be reported to the Board, including alleged violations of the nurse’s due process rights in relation to a nursing peer review proceeding.

Therefore, if permanent archiving is not possible, then the longest retention period possible is encouraged. Examples of nursing peer review records that should be submitted in response to a Board subpoena requesting all records related to a nurse under investigation includes, but is not limited to: The Board does not regulate practitioners who are not nurses, or facilities, agencies, or other entities that utilize the services of nurses. Thus, reports regarding other practitioners or entities should be reported to the appropriate licensing or regulatory agency not to the Board.The review includes whether external factors beyond the nurse’s control may have contributed to any deficiency in care by the nurse, and to report such findings to a patient safety committee as applicable.An employer may take disciplinary action before the nursing peer review committee is convened, as nursing peer review does not have to be utilized to determine issues related to employment. The role of the nursing peer review committee is to determine if licensure violations have occurred and, if so, if the violations require reporting to the Board.Because the nursing peer review committee is reviewing the incident solely to determine the existence of external factors, the due process rights of incident-based nursing peer review do not apply.The employer must make their own decisions about appropriate disciplinary actions; however, the employer may choose to utilize the decisions of the incident-based nursing peer review committee in determining what actions they wish to take with regard to the nurse’s employment.A combination of factors must be reviewed, including the nurse’s conduct, those factors viewed to be beyond the nurse’s control, and the relationship between the two that influenced or impacted the nursing practice breakdown.

If required remediation to address the deficit(s) in the nurse’s knowledge, judgment, skills, professional responsibility, or patient advocacy that contributed to the incident is not completed by the nurse, the nurse must be reported to the nursing peer review committee or to the Board if the practice setting does not have nursing peer review. (Note: If it was determined that remediation would not address the identified deficit(s) in the nurse’s knowledge, judgment, skills, professional responsibility, or patient advocacy that contributed to the incident, the conduct cannot be considered a minor incident and must be reported to the nursing peer review committee or to the Board if the practice setting does not have nursing peer review.) In determining whether multiple minor incidents constitute grounds for reporting the nurse to the nursing peer review committee or the Board if the practice setting does not have nursing peer review, an evaluation must be conducted to determine if the minor incidents indicate a pattern of practice that demonstrates the nurse's continued practice poses a risk of harm. If a nurse commits five minor incidents within a 12-month period, the nurse must be reported to the nursing peer review in practice settings with nursing peer review. In practice settings with no nursing peer review, the nurse who commits five minor incidents within a 12-month period must be reported to the Board.If a nursing peer review committee finds that a nurse engaged in conduct that is subject to reporting, the committee must file a signed, written report to the BON that includes: If there is no reasonable factual basis for determining that a practice violation is involved, the IBNPRC can either report the nurse to the Board or to a Board-approved peer assistance program.

IfThe incident-based nursing peer review (IBNPRC) committee must reconvene following suspension ofnursing peer review of the nurse who was impaired or suspected of being impaired for the sole purpose of determining whether any factors beyond the nurse’s control contributed to a practice violation and any deficiency in external factors enabled the nurse to engage in unprofessional or illegal conduct. If the committee determines that external factors do exist, the committee must report its findings to the patient safety committee or the CNO if there is no patient safety committee. Remember that because the nurse’s practice is not being reviewed (only the surrounding factors), due process rights for the nurse do not apply.For the purposes of exchange of information, the nursing peer review committee reviewing the conduct is considered as established under the authority of both so that the confidentiality requirements of nursing peer review are enforceable against any nurse involved in the investigation or the nursing peer review proceeding. The two entities may choose to have a contract with respect to which entity will conduct incident-based nursing peer review of the nurse. When invoked in good faith, safe harbor protects a nurse from employer retaliation, suspension, termination, discipline, discrimination, and from licensure sanction by the Board of Nursing (“BON” or “Board”). Safe harbor must be invoked prior to engaging in the conduct or assignment for which nursing peer review is requested, and may be invoked at any time during the work period when the initial assignment changes.Do I fax it to the Board of Nursing? The BON does not conduct nursing peer review. The content of this notification must meet the requirements for a Safe Harbor Quick Request.

If a nurse is unable to complete a Safe Harbor Quick Request or other written form meeting the requirements for a Safe Harbor Quick Request due to immediate patient care needs, the nurse may orally invoke safe harbor by notifying the nurse’s supervisor of the request. After receiving oral notification of a request for safe harbor, the nurse’s supervisor must record in writing the requirements of a Safe Harbor Quick Request, which must be signed and attested to by the requesting nurse and the nurse’s supervisor who prepared the written record. A detailed written account of the safe harbor request that meets the requirements of the Comprehensive Written Request for Safe Harbor Nursing Peer Review must be completed before leaving the work setting at the end of the work period. Please review the instructions on the BON Comprehensive Written Request for Safe Harbor Nursing Peer Review Form. The forms provided by the BON are meant to be a helpful resource to ensure you include all of the necessary information in your request. Remember, you are not required to use the forms provided by the BON; however, your request must be written and include the information outlined in Board Rule 217.20 (d). After receiving oral notification of a request, the nurse’s supervisor must record in writing the requirements of a Safe Harbor Quick Request, described in Board Rule 217.20(d)(3), which must be signed and attested to by the requesting nurse and the nurse’s supervisor who prepared the written record. The rationale should refer to one of the justifications described in Board Rule217.20(g)(2) for not engaging in the conduct or assignment awaiting a nursing peer review determination; Additional documents may be submitted to the committee when available at a later time; and Please do not submit any safe harbor request forms to the Board.

A collaborative effort with patient safety as the focus will require the nurse and supervisor to explore additional options that are safer for both the patient(s) and the nurse(s). The BON does not have authority over civil or criminal liability issues. Safe harbor does protect a nurse invoking safe harbor in good faith from retaliation by an employer or contracted entity for which the nurse performs nursing services. There is no expiration of the protection against retaliatory actions such as demotion, forced change of shifts, pay cut, or other retaliatory actions against the nurse. The nurse involved in either type of nursing peer review must agree to the use of the informal workgroup.Should you have further questions or are in need of clarification, please feel free to contact the Board. The Texas Board of Nursing's (BON) Nursing Practice Advisory Committee (NPAC) initiated an online survey. The States of Wisconsin, New Mexico, and Colorado are now part of the eNLC. The goals of this project were to identify standards of profes sional performance which d escribe behaviour of competent professionals. Peer review is the evaluation of an individual’s profes sional perform ance for relevant competency categories by using multiple sources of data. Catherine Hospital. This system of peer feedback is generally acceptable to the participants. The experience suggests that the approach enhances understanding of roles and responsi bilities and is s upportive to inter professional team develop ment. The peer review had positive outco mes, part icularly in t he planning o f future development of education and staff training, as well as in general professional development of the nurse s and the nurs e leader.Understa nding the ob jectives and distinctions between the annual performance review and peer review is important to ensure that both processes achieve their intended purposes.