Peer Review Tip: Distinguishing the Difference Between Peer Review, Peer Evaluation, and Peer Feedback

Rhonda R. Foster

EdD, MPH, MS, RN, NEA-BC

Magnet^®

Energetic, visionary, authentic and insightful, Rhonda Foster is a published and highly sought-after hospital consultant with a penchant for driving change, quality and organizational improvement. Her consultation experience has allowed her to provide expertise in the United States in community hospitals, academic medical centers, and systems, as well as to organizations in Brazil, Abu Dhabi and Qatar. In addition to being a consultant, Foster has a wealth of nursing administration and leadership experience, having served as vice president for clinical services and CNO for Children’s Hospital of Los Angeles, interim senior vice president and chief nursing and patient care services officer at City of Hope National Medical Center in Duarte, Calif.; interim CNO with St. Joseph Health—Sonoma County in Petaluma, Calif.; vice president of patient care services and CNO at Children’s Hospital of Michigan in Detroit; and assistant vice president of Women & Children’s Services at Mercy Health—St. Vincent Medical Center in Toledo, Ohio. She has earned a doctorate in education from Bowling Green State University, a Master of Public Health degree from the Northwest Ohio Consortium for Public Health, a Master of Science degree in nursing administration from Georgetown University, and a bachelor’s degree in nursing from the University of Toledo, where she was celebrated as the Outstanding Alumnus in Nursing. In addition, Foster was honored by the Los Angeles Business Journal as a 2021 Women of Influence in Healthcare. She also holds numerous certifications and board appointments and has authored more than a dozen publications on nursing, leadership, and quality improvement.

Energetic, visionary, and insightful, Dr. Rhonda Foster is a published and highly sought-after hospital consultant with a penchant for driving change, quality, and organizational improvement. While she served as the vice president of patient care services and chief nursing officer for the Children’s Hospital of Michigan, Dr. Foster’s collaborative and transformative leadership style led to innovative patient-care programs and the esteemed ANCC Magnet Recognition®. Dr. Foster now works full time as a consultant and educator. She is based in California and serves clients around the world.

An expert in a variety of Health care topics, Dr. Foster has been a featured presenter at American Nurses Credentialing Center (ANCC) conferences and seminars, and over the course of her esteemed professional career, Dr. Foster has traveled the globe conducting lectures and seminars on quality Health care delivery, hospital administration, and leadership. During her tenure as chief nursing officer of the St. Joseph Health System of Sonoma County, Dr. Foster was considered an empathetic advocate and was lauded for her ability to inspire and motivate others toward a common vision.

Dr. Foster’s primary strength is her ability to put theory into practice. Understanding the benefits of technological advances in Health care administration, Dr. Foster, a catalyst and early adopter, led the implementation of an electronic medical record system that provided computerized physician order entry and ease in nursing documentation and medication administration. In addition, prior to its becoming a widely accepted practice, Dr. Foster implemented a nurse residency program for new graduate nurses that resulted in a 40% reduction in turnover.

Credible and scholarly, Dr. Foster’s work can be found in the Journal of Nursing Management, Oncology Nursing Society publications, and other reputable print and online resources. Dr. Foster has a master of science degree from Georgetown University, a master in public health degree from the Northwest Ohio Consortium, and a doctorate of education in leadership studies from Bowling Green State University.

Summary of Services

Conducts readiness assessments and provides strategies for success.
Develops customized education and training to support organizational needs.
Assists organizations with document development and review.
Submits electronic documents.
Conducts comprehensive on-site assessments in preparation for site visits.
Works with all stakeholders to achieve organizational goals and strategic alignment.

Education

ADN – Michael J. Owens Technical College
BSN – University of Toledo
MSN – Nursing Administration in Health Services – Georgetown University
Master's in Public Health Administration – Northwest Consortium for Public Health
Doctorate of Education in Leadership Studies – Bowling Green State University

Certifications

American Nurses Credentialing Center – Certificate Holder in Fundamentals of Magnet®
American Nurses Credentialing Center – Nurse Executive, Advanced

Professional Memberships

American College of Health Care Executives
American Nurses Association
American Organization of Nurse Executives
National Association of Health Service Executives
Sigma Theta Tau International

It is not uncommon for me to have questions during a consultation about the "peer requirements." Before addressing what is required for the Organizational Overview or application documentation, it is important to distinguish the difference between peer feedback, peer evaluation, and peer review. Moreover, who is considered a peer?

A peer is someone of the same rank, education, clinical expertise, and level of licensure who performs similar roles.¹ The ANA Peer Review Guidelines position statement says, "As the professional association for nursing, ANA has a responsibility to the public and its members to facilitate the development of a quality assurance system including peer review."² Given that, each nurse must participate with other nurses in the decision-making process for evaluating nursing care; this process is called peer review. It is the process of peer review that stimulates professionalism through increased accountability and promotes the self-regulating nature of the nursing profession.

Peer review is defined as "an organized effort whereby practicing professionals review the quality and appropriateness of services ordered or performed by their professional peers." In nursing, it is the “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 of peer review is practice. It is the mechanism used to:

Evaluate the quality and quantity of nursing care based on practice standards.
Determine the strengths and weaknesses of nursing care based on practice standards.
Provide evidence for change in practice protocols to improve care.
Identify practice patterns that indicate a need for more knowledge.³

Peer review is not intended to be punitive or anonymous. In addition to considering the rank of the nurse and nursing practice, it is intended to take into account the developmental stage of the nurse, to foster a continuous learning culture of patient safety and best practice, and to provide feedback that is continuous, timely, and routine.

Peer evaluation is an element of performance evaluation and is generally linked to professional goals, compensation, and consequences. Peer evaluation is always completed by a peer; but if it is done as a part of a 360-degree process, all members of the contributing team (some may or may not be peers) should complete the evaluation. Peer evaluation is voluntary; peer review is not. Conducting 360-degree evaluations is an option for the organization; peer review is NOT optional for a professional.⁴

The Organizational Overview (OO-10) requires evidence of the following documents for nurses at all levels (staff nurses up to the CNO):⁵

Self-appraisal tools.
Peer feedback tools.
Performance review tools.

The self-appraisal tool, sometimes referred to as the self-evaluation, is the tool that the individual utilizes to evaluate his or her own performance against specific standards, goals, and objectives. The peer feedback tool is the tool used by peers to evaluate their peer’s performance against specific organizational standards, goals, and objectives. It is designed to provide input based on observed performance and enables the receiver to have an understanding about personal and professional strengths and gaps in practice or performance. Peer feedback is a way for a staff member to gain additional insight about his or her performance and/or validate a personal perspective or point of view.⁶ It should enable the receiver to walk away understanding exactly what he or she did and the impact.

Exemplary Professional Practice (EP15) states, "Nurses at all levels engage in periodic formal performance reviews that include a self-appraisal and peer feedback process for assurance of competence and continuous professional development."

Provide one example, with supporting evidence, of clinical nurses using periodic formal performance review that includes a self-appraisal and peer feedback process to enhance competence or professional development.

AND

Provide one example, with supporting evidence, of nurse leaders using periodic formal performance review that includes a self-appraisal and peer feedback process to enhance competence or professional development.

Note: The CNO and nurse educators are included in "nurse leaders."⁷

As you can see, the requirements are specific, and it is imperative that the terms not be confused, as the performance review, self-appraisal, and peer feedback processes are specifically designed in this source of evidence to enhance the competence or professional development of the clinical nurse or leader.

In conclusion, nurses are responsible for assessing their own competence.⁸ Competence is a self-regulating duty. Nurses are responsible for both peer and self-assessments, and must strive for excellence in their nursing practice, whatever the role or setting.

Barbara Haag-Heitman and Vicki George; Nursing Peer Review: Principles and Practice; American Nurse Today; September 2011; Volume 6, Number 9; p 48-52.
Peer Review Guidelines; American Nurses Association; 1988.
Barbara Haag-Heitman and Vicki George; Peer Review in Nursing: Principles for Successful Practice; Jones and Bartlett Publishers; 2011.
Jennifer M. Dupee, MBA, BSN, RN; Neysa P. Ernst, BSN, RN; and E. Kelly Caslin, BSN, RN; Does Multisource Feedback Influence Performance Appraisal Satisfaction?; Nursing Management; August 2014; p 10-20.
2014 Magnet® Application Manual.
Peer Feedback: Learning from College of Registered Nurses British Columbia; May 2006; p 1-4.
2014 Magnet® Application Manual.
Code of Ethics for Nurses with Interpretive Statements; American Nurses Association; 2015; p 16 and 22.

This article was originally published in April 2015.

*Use of ANA Consultation Services does not guarantee you will achieve an ANCC credential. ANA consultants and staff cannot influence the actions of ANCC program staff nor decisions of the Commission on Magnet® Recognition, Commission on Pathway to Excellence®, or Commission on Accreditation in Practice Transition Programs and the Commission for Nursing Continuing Professional Development..