Froedtert Hospital Hosts Magnet™ Workshop on Peer Review

Barb Haag-Heitman, PhD, RN, PHCNS-BC


June 04, 2009

On October 30, 2008, Froedtert Medical Center and the American Nurses Credentialing Center (ANCC) hosted a day-long workshop on peer review. Julie Gruver, BSN, RN, Froedtert Magnet Program Manager, reports "Froedtert Hospital was proud to be able to host the ANCC Peer Review Magnet workshop. As a Magnet designated hospital, we are committed to implementation of best practice standards such as peer review. The practice of peer review is useful in all nursing roles and serves to enhance nurses' professional growth." Nurses from Milwaukee area, Chicago, Iowa, and New York spent the day examining the professional foundation, background, principles, and best practices surrounding peer review in nursing.

This is the fourth national peer review workshop sponsored by the ANCC since July 2007. Hospitals across the country are realizing the significant role that peer review plays in creating cultures of excellence in quality and patient safety. The Magnet Recognition Program® criteria emphasizes the important role of peer review and requires evidence of effective peer review for nurses at all levels of the organization in the updated 2008 manual.

Although the American Nurses Association (ANA) first published nursing peer review guidelines in 1988 with an emphasis on quality care, peer review has not yet fully translated into practice. Peer review, according to the ANA guidelines and Magnet program manual, is the process by which practicing RNs systematically assess, monitor, and make judgments about the quality of nursing care provided by peers, as measured against professional standards of practice. It means that each nurse must participate with other nurses in the decision-making process for evaluating nursing care. Each nurses' obligation to engage in meaningful and well defined peer review processes is also highlighted in the ANA Code of Ethics for Nurses (2001).

Traditional Practices and Misconceptions

Too often peer review carries the mistaken belief of being punitive in nature and a managerial process, especially when conducted at the same time as the annual performance review. Traditionally, direct care nurses are asked to give yearly input into their peers' evaluations for overall general aspects of the nursing role. This feedback is usually given anonymous and therefore the receiver is not able to seek clarification or learning about any identified issues. Additionally, rather than associated with specific nursing practices with targeted quality and safety initiatives, peer review is often related to the citizenship aspects of performance such as whether they are pleasant to work with or if their work is satisfactory overall. This traditional process is sometimes called 'pal' review and lacks evidence to its effectiveness.

Rather than disciplinary, peer review should be considered educational and developmental, and feedback should be timely and foster continuous learning cultures of patient safety and best practice as originally intended.

Best Practices

Peer review should be ongoing and performed in a variety of ways, at all levels of the organization. Opportunities for peer review exist in the specific initiatives of quality and safety focuses such as decreasing central line infection, ventilator associated pneumonia (VAP), increasing hand washing, enhancing breastfeeding, etc. In each area, the specific evidence based standards need to be identified, communicated, and measured.

For example, the well-defined guidelines for ventilator associate pneumonia make it an ideal area for peer review during patient hand-offs, with the peer-to-peer dialogue centering on nursing care activities to prevent VAP. Nationally, when RNs focus on these standards and hold each other accountable using peer review we see a decrease in VAP. Other areas for peer review include clinical ladder promotion, case review, and credentialing. Advanced practice nurses and nurse administrators must also identify meaningful peer review practices.

Pam Scherff, MSN, RN, NE-BC; Director, Cardiovascular and Surgical Nursing at Froedtert Hospital and a workshop participant, shared the following perspective. "It is intuitive that nurses should be involved in peer review to ensure quality nursing care for our patients. Incident based peer review provides a process for nurses to review nurses. This process supports nurse autonomy and accountability and may result in positive changes that prevent further adverse outcomes. Attending the ANCC Peer Review Workshop provided me with evidence based practices that can be easily integrated into our current structures and processes to improve overall patient care."

Overcoming Barriers to Peer Review

Workshop participants across the country express the biggest barriers to peer review as fear of retaliation and lack of skill in giving feedback that won't hurt the relationship. Participants practiced using an adapted version of the commonly used SBAR tool (Situation-Background-Assessment-Recommendation) named the SBIR. The components of SBIR include: state the Situation; describe the Behavior; state the Impact on the RN team, patient, or family; and make a Recommendation for change in behavior or practice choosing a solution.

Training in giving and receiving focused and meaningful feedback is an essential part of a quality peer review process and a key to the success of any program.

For information about this and other ANCC workshops, please visit:

This content is provided by American Nurses Credentialing Center (ANCC) for publication on the website.

The American Nurses Credentialing Center's (ANCC) internationally renowned credentialing programs certify nurses in specialty practice areas, recognize healthcare organizations for nursing excellence through the Magnet Recognition® and Pathway to Excellence Programs, and accredit providers of continuing nursing education. In addition, ANCC offers an array of informational and educational services and products to support its core credentialing programs.

ANCC is passionate about helping nurses on their journey to nursing excellence. Visit ANCC's web site at

The American Nurses Credentialing Center (ANCC) is a subsidiary of the American Nurses Association (ANA).


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