Implementation of Nursing Peer Review Within Shared Governance to Improve Patient Outcomes

       Nursing is at the core of our nation’s current demand for perfect care and the care that nurses provide is central to patients’ achieving quality outcomes.  The current healthcare landscape is filled with public reporting of hospitals’ quality measures.  The national regulations administered by the Center for Medicare and Medicaid are determined to provide financial awards and penalties to hospitals for their reported clinical outcomes (Robert Wood Johnson Foundation, 2012).   The Institute of Medicine (2010) report, The Future of Nursing:  Leading Change, Advancing Health, recognizes the extensive ability of nursing to touch patients in all healthcare settings and confirms that the care provided by professional nurses is an essential component of patients achieving optimum clinical outcomes.  The practice environment of nurses in the acute care setting has been studied to determine what constitutes the ideal structure that facilitates optimal professional nursing practice.  The literature supports that shared governance is the structure that enables nurses to practice with input into decisions impacting delivery of care (Barden, Quinn, Donahue, & Fitzpatrick, 2011).   The nursing profession is guided by professional standards such as the American Nurses Association’s guidelines for nursing peer review, published in 1988 (ANA, 1988). 

      The professional responsibility of peer review was first acknowledged by Nightingale (1860) in her book, Notes on Nursing, where she wrote that it is a greater challenge to have the right thing always done as opposed to always doing the right thing yourself; reflecting on the need for nurses to provide peers with support and feedback for optimal care.   Hospitals attaining designation as a Magnet hospital by the American Nurses Credentialing Center are accepted to demonstrate the highest level of nursing practice (ANCC, 2013). The Magnet program requires that hospitals have shared governance and nursing peer review in place (ANCC, 2013).

     The literature review notes that shared governance was introduced in the 1980’s in an attempt to decrease the nursing turnover that was occurring in hospitals at that time (Barden et al., 2011).   There are numerous studies that confirm nursing shared governance is linked to nurses having increased job satisfaction and increased perceptions of empowerment in the workplace, however there are few studies linking shared governance to improved patient outcomes (Hess, 2011).   Fewer studies exist linking the implementation of nursing peer review within shared governance to positive patient outcomes (Brann, 2014, Brooks, 2004).  The purpose of this project is to demonstrate a positive link between the implementation of nursing peer review within shared governance to the clinical outcome of reduced patient fall rates.