Although the concept of nursing peer review is over two decades old, it is just coming of age in the correctional nursing specialty as the newest version of the National Commission on Correctional Health Care Accreditation Standards has expanded the Clinical Performance Enhancement Program (Standard C-02) to include RNs and LPNs. This is the first in a 4-part series on correctional nursing peer review.
Peer review is a familiar program to providers (physician, nurse practitioner, physician assistant) as a means of evaluating the quality of care provision by individual practitioners. Nurses, however, can have difficulty applying this concept to their own clinical practice. The American Nurses Association’s (ANA) Nursing Peer Review Guidelines provides a definition and set of principles for the nursing peer review process that are applicable in the correctional setting.
What It Is
The original ANA definition of nursing peer review stands today as an appropriate description of the process:
“Peer review in nursing is the process by which practicing registered nurses systematically access, monitor, and make judgments about the quality of nursing care provided by peers as measured against professional standards of practice”
Breaking down the components of this definition supplies key concepts for a nursing peer review program in corrections:
Practicing Registered Nurses
Peer review should be performed by nurses who are practicing in a similar context. Thus, it would not be appropriate to have critical care nurses evaluate the nursing care of correctional nurses or for emergency nurses to evaluate the care of neonatal nurses. Nurses practicing in a similar context understand the environment of care, the patient population, and the standard processes for accomplishing care that would not be familiar to a nurse from another context.
Assess, Monitor, Make Judgments
Peer review is an evaluative judgment about the actions of another staff member from the same profession. The primary objective is to determine the quality and safety of care provided by an individual staff member.
Nursing Care Provided
A major component of the definition of nursing peer review is that it is a judgment of actual care provided. This is often done as a chart review but could also be performed as direct observation. However, the evaluation is of actual nursing care provided rather than a nurse’s ability to provide care.
Measured against Professional Standards of Practice
Accepted professional standards of practice are used to determine the quality and safety of care in a peer review. These accepted standards should be known to all members of the peer review process. For correctional nurses, professional standards of practice can come from
- ANA Correctional Nursing Scope and Standards of Practice
- State Board of Nursing Practice Act
- Accreditation Standards that Address Clinical Practice
What it Isn’t
There can be misconceptions about what constitutes nursing peer reviews. Based on the above defining qualities of a nursing peer review, these are not nursing peer review processes:
Annual Performance Evaluation
An annual performance evaluation is a judgment of an employee’s work as it relates to their hired status and job description. Although clinical practice is a part of a nurse’s job performance, it is often not the primary focus of the performance evaluation.
Nursing Competency Checklists
Competency checklists or skills reviews evaluate a nurse’s ability to perform various skills and functions. They do not evaluation actual nursing care provided.
Simulations Such as Man-Down or Disaster Drills
As with competency or skill evaluations, simulations such as man-down or disaster drills evaluate staff ability to perform in an emergency situation but do not evaluate actual nursing care in a real clinical situation.
Continuous Quality Improvement Projects
Continuous quality improvement projects look aggregately at clinical care provided while nursing peer review evaluates a specific clinician’s actual care provision.
Are you developing a Nursing Peer Review program in your setting? Share your experiences in the comments section of this post.
To read more about professional practice issues see Chapter 19 in the Essentials of Correctional Nursing. The text can be ordered directly from the publisher and if you use Promo Code AF1402 the price is discounted by $15 off and shipping is free.
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