chapter 6 | Getting People to Work Together 87A Comprehensive Peer Review System
Peer review systems can simply be informal feed-
back regularly shared among colleagues, or they
may be comprehensive systems that are fully inte-
grated into the formal evaluation structure of a
health-care organization. When a peer review sys-
tem is fully integrated, the evaluative feedback from
peers is joined with the performance appraisals by
the nurse manager, and both are used to determine
pay raises and promotions for individual staff nurs-
es. This is a far more collegial approach than the
hierarchical one typically used, in which employees
are evaluated only by their manager.
A comprehensive peer review system begins
with the development of job descriptions and
performance standards for each level within the
nursing staff. The job description is a very general
statement, whereas the standards are specific
behaviors that can be observed and recorded.
In a participative environment, the standards are
developed by committees having representatives
from different units and from each staff level, from
the new staff nurse to top-level management. In
some instances, they are very specific, quantifiable
criteria, but others are likely to require professional
judgment as to the quality of the care provided
(Chang et al., 2002).
In some organizations, the standards may be
considered the minimal qualifications for each
level. In this case, additional activities and profes-
sional development are expected before promotion
to the next level. The candidate for promotion to
an advanced-level position prepares a promotion
portfolio for review (Schultz, 1993). The promo-
tion portfolio may include a self-assessment, peer
reviews, patient surveys, a management perform-
ance appraisal, and evidence of professional
growth. Such evidence can derive from participat-
ing in the quality improvement program, evaluating
a new product or procedure, serving as a translator
or disaster volunteer, making post-discharge visits
to patients from the unit, or taking courses related
to nursing.
Writing useful job descriptions and measurable
standards of performance is an arduous but reward-
ing task. It requires clarification and explication of
the work nurses actually do and goes beyond the
usual generalizations. Under effective group leader-
ship and with strong administrative support for this
process, it can be a challenging and stimulating
experience. Without administrative support and
guidance, however, the committee work can be
frustrating when the group gets bogged down in
details and disagreements.
When the job descriptions and performance
standards for each level have been developed and
agreed on, a procedure for their use must also be
worked out. This can be done in several ways. In
some organizations, an evaluation form that lists
the performance standards can be completed by
one or two colleagues selected by the individual
staff member. In some organizations, the informa-
tion from these forms is used along with the nurse
manager’s evaluation to determine pay raises and
promotions. In others, the evaluation from one’s
peers is used for counseling purposes only and is
not taken into consideration in determining pay
raises or promotions. This second approach pro-
vides useful feedback but weakens the impact of
peer review.
A different approach is the use of a professional
practice committee. The committee, consisting of
colleagues selected by the nursing staff, reviews the
peer evaluation forms and makes its recommenda-
tions to the director of nursing or vice president
for patient care services, who then makes the final
decision regarding the appropriate rewards (raises,
promotions, commendations) or penalties (demo-
tion, transfer, termination of employment).Conclusion
The responsibility for delivering and coordinat-
ing patient care is an important part of the role
of the professional nurse. To accomplish this,
nurses need good communication skills. Being
assertive without being aggressive and conduct-
ing interactions in a professional manner
enhance the relationships that nurses develop
with colleagues, physicians, and other members
of the interdisciplinary team.
A major focus of the national safety goals is
improved communication among health-care pro-
fessionals. In an effort to improve patient safety,
health-care institutions have moved toward imple-
menting a communication protocol referred to as
the SBAR method. SBAR sets a specific procedure
that reminds nurses how to relay information
quickly and effectively to the patient’s health-care
provider, which ultimately leads to improved
patient outcomes.