What's the first thing that comes to mind when you hear the term "peer review"? If you answer peer review evaluations, that's a good start. But for the most advanced hospitals, peer review means a whole lot more.
"We have had peer review going on for many years and it is well-embedded here," said Sharon Cusanza, BSN, RN, CPHQ, director of Magnet and special projects at Ochsner Medical Center-New Orleans. "We have peer review components in evaluations, the interview process for potential hires, awards for our nursing education grant fund and our clinical ladder program."
Kelly Pratt, RN-BC, co-chair of the professional practice council at Ochsner, works as a patient care coordinator (PCC) on a postop surgical unit that's been doing peer review evaluations for 5 years.
"Our unit peer review committee includes the unit director, PCCs and permanent charge nurses," she said. "There are also elected members representing all shifts, including nurses, patient care techs and a unit secretary. The committee does the annual performance review for everyone, gathering as a group to give input. The unit director, one of the PCCs or a permanent charge nurse then sits down one to one with the staff member to do the actual evaluation. At that time, we bring up any issues the committee has identified."
At the end of the evaluation meeting, the employee and manager jointly compile a learning map that outlines goals for the next year. The goals may highlight opportunities for improvement or personal goals such as obtaining specialty certification.
"The process works well because our manager can't be there 24/7 to observe individuals," Pratt noted. "Peer review gives a voice to nursing staff observing the work of their colleagues."
Sue O'Brien, MS, RN, clinical nurse specialist in intermediate care at St. Mary's Hospital, Madison, WI, described the peer review evaluation process that's an integral part of the professional development model at her Magnet-designated facility.
"There are three components of our performance evaluation process: self-evaluation, peer review from three others and the performance evaluation by the supervisor that incorporates feedback from the first two components," she said. "We encourage nurses to give the peer review tool to someone who follows them on the next shift of their nursing unit or to a customer who can fairly evaluate their work. For example, a nurse working in a surgical procedure area may choose an operating room nurse, or a cardiovascular ICU nurse may ask a colleague in cardiac surgery intermediate care to complete the form."
Paula Carynski, MS, RN, NEA-BC, vice president of patient care services and chief nursing officer, OSF Saint Anthony Medical Center, Rockford, IL, talked about how her facility implemented a case review model that incorporates input from peers.
"We have a robust shared-governance structure with a nursing practice council as the oversight body," she explained. "Our executive coordinating council sanctioned a task force for nurse peer review; as chief nursing officer, I volunteered to spearhead the task force. Over the past 6-8 months, we conducted a literature search, queried the Magnet listserv, sat in on a Webinar on the topic and placed calls to several organizations that have peer review in place. At the last Magnet conference, I attended a concurrent session on the topic led by Barb Haag-Heitman, PhD, APRN-BC, and learned she resides in the Milwaukee area."
Nursing decision-makers at Saint Anthony chose a case review model for two reasons.
"First of all, we wanted a nonpunitive approach to improve quality in nursing performance within our organization," Carynski said. "Second, we wanted to tie peer review to our existing shared-governance structure and not create an entirely new peer review oversight group. So we developed our policy, tools for peer review, and tracking and trending mechanisms in coordination with our quality department. We then brought Haag-Heitman in to meet with our shared-governance chairs and co-chairs, as well as our charge nurses; that was a day well-spent. Having an outside expert share the history and importance of peer review intrigued people."