Date of Award

Spring 2025

Project Type

Clinical Doctorate

College or School

CHHS

Department

Nursing

Program or Major

DNP

Degree Name

Other

First Advisor

Cathleen Colleran

Second Advisor

Courtney Coffey

Abstract

Background: Peer review has been in use in healthcare for many years, primary by physicians. Recently, however, nursing has adopted a framework for peer review within the profession. According to the American Nurses Association (admin, 2011), organizations are required to maintain a systematic peer review process aimed at evaluating nursing care and nursing care providers to obtain/maintain Magnet designation. According to Foster (2015) nursing peer review (NPR) is “process by which practicing registered nurses systematically assess, monitor, and make judgments about the quality of nursing care provided by peers as measured against professional standards of practice”. The focus is on nursing practice with the goal of reducing medical errors, and improving outcomes related to practice standards, protocols and policies.

Purpose: The project’s objective was to determine if a nursing peer review program would provide an evidence-based platform for nurses to assess professional practice, comparing care provided to established patient care protocols and policies, provide for decisional involvement in nursing practice and recommendations to improve practice, while feeling empowered to shape change?

Methods: In this descriptive quality improvement project, the Conditions for Work Effectiveness Questionnaire II and the Decisional Involvement Scale were used pre- and post-implementation to assess the effect of nursing peer case review on nurses’ perceptions of autonomy and empowerment.

Interventions: NPR began with a two-hour training session where concepts of NPR were addressed, and simulated case review occurred. The committee reviewed cases that were referred via the quality department, patient safety department, and SICU staff. All cases identified were preliminarily screened and cases deemed appropriate for review were assigned to a member of the committee for workup and presentation. During monthly meetings, committee members presented reviews and findings to the committee. Members then discussed cases, determined if standard of care was met, and made recommendations for improvement to current systems, policies or procedures to benefit future patient outcomes.

Results: The Decisional Involvement Scale revealed nurses desire for increased decision-making with a focus on shared decision making between administration/management and nurses. The Conditions for Work Effectiveness Questionnaire II results showed increased empowerment after participating in nursing peer case review. There were improvements noted in the categories of empowerment, opportunities, resources, and support.

Conclusions: Incorporating nursing peer case review into the quality improvement model of the SICU provided opportunities for improved perceptions of nursing autonomy and empowerment while providing a method for frontline nursing to make recommendations for improvements to care. There was a clear desire from nurses to increase autonomy, with the result of improvements in overall sense of collaboration both within the unit and with professionals outside the unit.

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