Implementation of a Nursing Peer-Review Program in the Hospital Setting

Nursing peer review (NPR), a formal process by which nurses are referred for peer evaluation when patient care problems are identified, has gained acceptance as a method to improve nursing quality and safety. This article describes the development of a formal NPR program for acute care nurses, intended to validate and improve nursing practice.

Nursing peer review is a systematic process of assessing and evaluating nursing care by peers against professional practice standards. The purpose of an NPR program is to provide a pathway whereby peers hold one another accountable for practice.

Accountability is an important demonstrator of professionalism. Because nursing is a trusted profession, it is imperative that it demonstrate accountability.

The NPR program was developed and implemented by a clinical nurse specialist. A literature review was conducted to assist program development including the processes of building an NPR committee and nurses for review. To trigger referrals to the NPR system, nursing indicators were identified. To diminish fear among nurses, education for staff members focused on the purpose and importance of the NPR process and the intent to strengthen practice. Nursing peer review committee members were also educated in the use of NPR principles including just culture, appreciative inquiry, and confidentiality.

Upon implementation, nearly 200 referrals were received within the first 14 months; 85% met criteria for review. Nursing practice was identified as appropriate (ie, nursing actions were consistent with good practice) in 66% of the reviews. Trends in individual and system processes were identified for improvement.

The clinical nurse specialist's role as NPR program coordinator provided an innovative way to impact nursing and organizational spheres of influence through program development and implementation. Future goals include sustaining/improving nursing awareness of the NPR process and identification of additional indicators to trigger review.