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Use peer review to boost nursing autonomy and competence

After reading this article, you will be able to:

  • Discuss how to conduct peer review evaluations

by Gina Boring, MSN, RN, NE-BC

Peer evaluations and self appraisals can be useful tools to measure competence and professional development and promote professionalism and accountability.

Managers may want to consider instituting an annual peer review process, which can include various elements, such as feedback from six peers, feedback from the unit director (see Pella [IA] Regional Health Center’s peer review tool on p. 7), and a self-evaluation completed by the nurse being reviewed.

“The peer review tool has proven to be very worthwhile in offering objective input for peer evaluation for both the staff level and the leadership level,” says Yvonne O’Brien, MS, RN, CNO at Pella Regional Health Center.

Set goals

Help nurses improve professionally by having them set specific, measurable, action-oriented, realistic, and timely (SMART) goals during the peer review process. Then incorporate the goals into the nurse’s plan for the upcoming year. Once SMART goals are set by the employee, the manager’s role becomes that of a facilitator.

Follow-up on the goals set during a peer review/performance appraisal evaluation should occur two to six months after the initial plan is set. The measurable, realistic, and timely qualities of the goals, along with the level of employee engagement, will determine the follow-up interval.

If no progress is made, use the peer review feedback and goals to hold the nurse accountable. But if progress has been made, celebrate the accomplishments.

Evaluation process

Two powerful questions asked on many of our units are, “How well do you like following this nurse’s assignment?” and “How well do you like being assigned on the same team as this nurse?”

The first question allows the participants to discuss how well tasks and needs are addressed from the previous shift, charting completeness, handoff communication, patient satisfaction, or environmental issues. The second question addresses teamwork, witnessed quality of care, interaction with patients and family, and professionalism.

Each of the questions is answered using one of the following ratings:

  • 0 = Needs improvement
  • 1 = Consistently meets standards
  • 2 = Consistently exceeds standards

We ask that any rating of “0” include an explanatory comment, and space is provided for narrative feedback. Many organizations choose to have the feedback from peer review in a purely narrative format, which negates the need for a scoring or rating. The evaluation simply needs to fit the process.

Practicing a formal written peer review process provides nursing staff members with an opportunity to meet the highest performance expectations.

Thus, it’s important to work with staff nurses at all levels and across all settings to design a peer review process that meets the patient population served, the unit culture, and the mission and values of the organization.

Editor’s note: Boring is the ANCC Magnet Recognition Program® project director at Aultman Hospital in Canton, OH.


Adapted from HCPro’s Advisor to the ANCC Magnet Recognition Program®, June 2009, HCPro, Inc.