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Why conduct peer review?

Historically speaking, nurses have long conducted some level of peer review: Since the first nurse conferred with another about caring for a patient, some form of peer review has been in place. Yet when nurses are considering whether to implement a formal peer review process, or if the organization has already started down that road, many may wonder about the benefits of conducting peer review and ask questions like, "Why now?"

Time is of the essence. Medical staffs have been peer reviewing their cases for years, and as fellow professionals, we must hold ourselves to the same high standards. Nurses are professionals who must hold each other accountable and evaluate patient care so we can eliminate system and human errors. Nurses are no different than physicians in this way.

The goals and benefits of peer review include:

  • Improving the quality of care provided by individual nurses
  • Monitoring the performance of nurses
  • Identifying opportunities for performance improvement
  • Identifying systemwide issues

Achieving outstanding results

If the process of peer review is to be effective, then a formal structure must be created to allow for the tracking and trending of information and the identification of potential system or human failures. Case review is useful for this, as it presents opportunities to identify failures through investigation so nurses and other team members can correct them before injury occurs in a patient.

The right framework

Organizations do not achieve outstanding results by accident--they take a powerful, common-sense approach that motivates all employees to consistently do their best. The Walt Disney Company is a fantastic example of a company that takes such an approach to motivating employees and thus ensures that every single staff member in its theme parks is uniformly nice, upbeat, and helpful, whether that staff member is the person in the concession stand or the ticket taker or the person dressed up as Mickey Mouse. Another example of companies that understand and apply this process to provide outstanding service day in and day out are luxury hotels, such as The Ritz-Carlton.

Appoint excellent nurses

If you start by bringing people into the hospital who are well qualified and competent nursing staff, you improve your ability to reach the level of excellence you desire. For example, consider Disney Company employees. Why are they so polite and friendly? It's not simply because Disney trains them to be, but rather because the company carefully selects people who have these attributes in the first place.

Carefully selecting nurses requires solid screening systems. When a nurse first applies for a staff position, his or her professional credentials (e.g., licensure, education, experience, current competence) must be verified in accordance with policy and procedure, state and federal regulations, and accreditation standards (e.g., The Joint Commission or the National Committee for Quality Assurance).

This is the point where it is crucial to go beyond minimum requirements-do not stop here. Create and maintain the highest possible standard for nursing. For example, require applicants for positions in your facility to demonstrate excellent previous clinical performance, provide superior professional references, and demonstrate the ability to relate well to colleagues and other employees.

Set and communicate expectations

Few organizations take the time to define and explain in one document what is expected as a nurse on staff in the organization. Despite the importance of doing so, nursing departments often do not set and communicate expectations well.

The nursing department should tell every new nurse, in writing, what is expected of him or her to achieve excellence. This is your opportunity to establish expectations for the type of nursing culture you want. In a one-page document, define the routines and protocols that are used and acceptable in the organization. Consider it a statement of the culture of the nursing staff, including information about how the staff does things at our facility. It could even be viewed as a kind of executive summary of the organization's policies and procedures.

At the least, the document should outline the essential dimensions of nursing performance:

  • Technical quality of care
  • Patient safety and rights
  • Quality of service
  • Resource utilization
  • Peer-to-coworker relationships
  • Contributions to hospital and community

Editor's note: This excerpt was adapted from HCPro's new book, Nursing Peer Review: A Practical Approach to Promoting Professional Nursing Accountability. Take a longer look inside the book here or purchase a copy here.