During your nursing career, you may have to take part in a process known as peer review in which you evaluate one or more of your colleagues' work performance. At some facilities peer review takes place on a regular basis and focuses on quality and safety, says NurseZone.com. If you must write a peer review, remember your words must be constructive and aimed at improving the quality of care patients receive. The process helps educate fellow nurses, not punish them. Consider several steps when writing a nursing peer review.
- Skill level:
When considering how to sculpt your nursing peer review document, be certain about the underlying reason for the review. Ask your supervisor if you need clarity before beginning. For example, ask, "Is it a yearly assessment?" Because most states don't have mandated peer review programs from their board of nurses, the frequency of peer reviews may be based on your hospital's nursing evaluation policies or its participation in the Journey to Magnet Excellence program. Also, ask if the peer review is in response to a failure in compliance by a nurse or unit. In the state of Texas, for example, there are two types of nursing peer reviews: incident-based (IBPR), where the review is initiated by a facility, and safe harbour (SHPR), which is initiated by a nurse who feels she was asked to perform a duty that could put a patient at harm. If a nurse prepares the review as a part of SHPR, she is protected from retaliation from her employer or licensure agency. Because the reasons for peer review in IBPR and SHPR vary, there is no set length the reports should be. Both reviews should clearly detail the circumstances of the incident, as well as the standard of care that was expected. For example, if it is policy to rotate each immobile patient three times a day to reduce the incidence of bedsores and a supervisor asked you to perform blood draws and forgo patient rotations or falsify records to say that patient was in fact rotated, you should file an SHPR.
Know your review audience. Sometimes you must present your review to an audience in addition to preparing the written document. The audience will most likely be a nurse council made up of RNs and LPNs. Be sure that your document is concise and is consistent with what you are willing to say in a public forum. Determine whether your review will become part of a nurse's personnel file. Be sure to detail the incident being evaluated and the conduct involved including the date, time, location and any individuals involved. Provide your name and contact information as well if the review is not anonymous.
Avoid accusatory tones. While it is important to highlight the weaknesses and areas in need of improvement, it is important to not appear accusatory or condescending. Give praise where it is due, and offer examples of ways to comply or improve problematic processes. For example, if a nurse is recorded as using long periods to process medication orders, consider the possibility that the ordering system may be technically flawed, or that she may be surpassing performance in other areas such as patient counselling at the cost of medical ordering. Don't assume the nurse herself is solely at fault without evaluating the process systemically. Remember the goal of peer review in nursing is to maximise the quality of patient care in real time. A peer review that incites conflict can stunt the process.
Offer the nurse being reviewed an opportunity to provide feedback. Arrange a time to sit down with the team or nurse who is being reviewed, or provide additional forms for him to respond to the review, especially if it will become a part of the permanent record. In the state of Texas, for example, a nurse or his attorney may review a peer review report 15 days before the committee meets. At the meeting or hearing, the nurse can make a statement, ask and respond to questions, and prepare a written statement for the nurse council. The nurse is also allowed to call witnesses and provide written testimony. The nurse council must deliberate and complete the evaluation within 14 days of the peer review hearing. Thereafter, the nurse has 10 days to make a rebuttal.
Tips and warnings
- If you fail to appropriately document a nurse's actions in order to have her avoid repercussions, you also may be subject to penalties from your state board of nursing.
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- Nurse Zone: Peer Review Offers Opportunities to Improve Nursing Care
- Texas Board of Nursing: FAQs - Nursing Peer Review
- Health Leaders Media: Nursing: Nurse Leaders Should Champion Peer Review
- Texas Board of Nursing: Nursing Practice Act
- American Nurses Credentialing Center:Journey to Magnet Excellence