Nursing Peer Review: Definition and Example

Nursing gained prominence throughout the 1800s and early 1900s as increases in the population created new medical challenges and world wars heightened the need for nursing care. In 1926, the American Nurses Association (ANA) created a formal code of ethics for nurses, and from there, a more defined view of the nursing profession and how to achieve quality nursing took shape.

In 1958, nursing leader Ida Jean Orlando defined the nursing process , paving the way for the publication of the ANA Peer Review Guidelines in 1988. These landmark moments represent an advancement in the profession toward organized, systematic improvement of nursing care and patient outcomes.

Since the early 1990s, nursing peer review has been a consistent, important part of that advancement. It supports professional growth and collaboration and emphasizes learning and practice — just like the online nursing programs of today.

What’s Nursing Peer Review?

Nursing peer review is a structured practice that enables nurses of the same rank to provide feedback to one another about patient care based on standards of care. Face-to-face sessions encourage collaboration and mentorship; written feedback enables a nurse leader to compile the information and identify patterns in patient care that may need to change. In this way, nursing peer review is a collaborative effort among nurses to improve patient care while also helping them learn from one another. It’s not a formal evaluation process that ties feedback to decisions about a person’s role or compensation.

How Does Nursing Peer Review Work?

Nursing peer review encompasses six principles, according to the Peer Review Guidelines:

1. A peer is a professional of the same rank.

2. The process must be focused on the practice of nursing (not on an individual’s characteristics).

3. The practice is continuous, and feedback is timely.

4. The practice emphasizes a culture of learning.

5. Nurses are paired to deliver face-to-face and written feedback.

6. The nurse’s level of experience is considered.

These principles establish nursing peer review as what it’s meant to be — a collaborative effort to improve care and outcomes — rather than a formal, top-down evaluation process.

A successful nursing peer review relies on:

• Organized leaders introducing and rolling out the process in a way that matches their leadership style

• An easy-to-follow structure that busy nurses can complete at natural breaks in their shifts

• Smart pairings of novice and seasoned nurses to encourage knowledge transfer

• Well-documented and widely accessible standards of care for the nursing unit, such as the Code of Ethics for Nurses

• A relevant and purposeful focus area or theme for the review

• Technology or other supports that make it easy for nurses to write the review

With these principles and methods established, nurses can conduct a round of nursing peer review to tackle a particular care challenge. They can learn from one another, help leaders identify patterns, and ultimately advance patient outcomes. Findings can also help nurses delegate more effectively to nursing assistants and care technicians on their teams.

Where Do Focus Areas for Nursing Peer Review Come From?

While nursing peer review is a continuous practice that helps nursing units improve together, the targeted need for a round of review may come from a particular source, such as:

• Data from a routine report compiled by hospital administrators

• Patterns unearthed by an external consulting firm

• Information from a government audit on certain benchmarks

• Insights from nurses about common uncertainties

• Goals set by hospital or department leaders

A nurse leader might take a data point from any of the sources and decide to explore related issues further through nursing peer review.

Nursing Peer Review Example: IV Usage

Consider a scenario in which an external consulting firm finds instances in which medications arrive late. They discovered that in these instances, the method of delivery for the medication was IV therapy — that is, fluids administered through an IV. The finding spurs the need for a round of nursing peer review that focuses on the following:

• What issues the IVs themselves may be causing

• The gaps in knowledge or skills among nurses when working with IVs that may be causing issues

• Which, if any, of the nurses in the group don’t encounter this problem and can share their methods with others

In application, the round of peer review would look something like this:

1. Two nurses meet briefly during shift handoffs and discuss challenges, successes, questions, and solutions they’ve found while delivering medications via IVs

2. Both nurses document the others’ methods, their addressed misconceptions, and any improved outcomes over the course of a few days, as they continue to meet.

3. Both nurses write up their review of their peers’ methods and submit it to a nursing leader, who can analyze trends and identify what may be causing the issue.

4. The nurse leader can share findings, change equipment if needed, and call for training to ensure that the issue is ultimately resolved.

In this example of nursing peer review, the practice is used to help a nursing unit execute a targeted exploration of an important issue that surfaced in the data collected by a particular source. It can support nurses’ professional development and collaboration while continuously improving patient care. When the emphasis is on structured practice, meaningful feedback, relationship building, and learning, peer review in nursing can be a valuable tool to further a nursing unit’s effectiveness and growth.

Thrive in the Nursing Field With The University of Tulsa’s Online Nursing Programs

The important practice of nursing peer review relies on the clinical and interpersonal skills of great nurses who take their collaboration and growth mindset from the classroom to the nursing floor. Depending on where you are in your nursing journey, numerous educational pathways are available to help you reach your goals. That’s why TU, which has been educating prospective nurses since 1978, established online nursing programs to help you get where you want to go.

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Recommended Readings

6 Tips for New Nurses

Nurse Leader vs. Nurse Manager: Differences and How to Advance

Chief Nursing Informatics Officer Career Overview

Sources:

American Nurse Journal, “Nursing Peer Review: Principles and Practice”

American Nurses Association, “Peer Review Tip: Distinguishing the Difference Between Peer Review, Peer Evaluation, and Peer Feedback”

American Nurses Association, Teamwork in Nursing: Team-Building Strategies for Better Patient Care

American Nurses Association, View the Code of Ethics for Nurses

Indeed, “What Is Peer-to-Peer Learning? (And How to Use It at Work) ”

Massachusetts General Hospital, MGH Nursing Peer Review (NPR) Process – Staff Nurse