Facing It Together: Face-to-Face Peer Review That Inspires Professional Growth 2016 ANCC National Conference October 5, 2016 11:30am-12:30pm Session C516 April Adley, MHA, BSN, RN Peter Andrews, BSN, RN Judy Himes, MSN, RN, NE-BC Abigail Rudy, BSN, RN, CCRN, NE-BC Penn State Health Milton S. Hershey Medical Center
Disclosures The presenters for this presentation have disclosed no conflict of interest related to this topic.
Annual Statistics Beds: 548 Total Admissions: 28,654 Total Outpatient Visits: 1,034,663 ED Visits: 72,493 Births: 2,087 Surgical Procedures: 30,028
Nursing Department Profile Total RNs: 2,460 Percent Certified: 42.9% Percent BSN: 72.4%
Professional Practice Model
Peer Review or Peer Feedback? Standards-based peer review In the moment- peer feedback
Clinical Ladder and Peer Review Historically peer review addressed all domains Clinical Ladder- 6 domains Domain 1: The Caring Role Domain 2: Teaching and Coaching Domain 3: Clinical Practice
Domains (cont.) Domain 4: Monitoring and Ensuring the Quality of Health Care Practices Domain 5: Professional Collaboration and Consultation Domain 6: Clinical Knowledge Development
Clinical Ladder and Peer Review Historically embedded in Clinical Ladder Focus was for level III and IV clinicians Clinical Ladder 4 RN levels: Level I: Novice nurse Level II: Competent clinical nurse Level III: Proficient nurse application required Level IV: Expert nurse application required
Peer Review Incorporated ANA Scope and Standards 2010 in electronic process Peer review shifted to mid-year Progress measured at end of year evaluation
Performance Evaluation Cycle Evaluation year begins End-of-year evaluations/goal setting Peer review occurs Mid-year evaluations
History of Giving Peer Review Nurse leaders: Face to face process Professional accountability Clinical nurses: Electronic Anonymous Limited comments
Motivation for Change ANA Scope and Standards Professional standards Increase review effectiveness
Timeline Break out session May 2015 Pilot on MICU and PIMCU August 2015 Introduced peer review process to department councils October 2015 Education November 2015 All peer reviews completed January 31, 2016
Change Process Clinical Ladder Committee 3-hour breakout session Focus on Domain 4 Peer-led education Shared governance pairing
Why Domain 4 Align with ANA Scope and Standards Objective and less subjective review Manage time constraints Improve quality outcomes
Peer-Led Education Used Clinical Ladder III and IV nurses One on one sessions Peer Review Packet as a guide
New Peer Review Process Focus on the conversation Resource packet Guided questions Individual ownership
Guided Questions What work have I already done in this domain that has positively impacted my work environment? What could I currently be doing better in this domain? (Safety issues, quality care, fiscal responsibility, issues resolution) What could I do over the next year to positively impact the quality domain?
Implementation Plan Pilot units Medical Intensive Care Unit Pediatric Intermediate Care Unit Outcomes Collaboration of ideas Diversity in nursing Shared governance
Implementation Plan Role of shared governance Integrated vs council model Clinical nurse pairing process Years of experience Clinical ladder status Charge nurse Day/Night shift
Survey of pilot units Pilot Evaluation What worked and what didn t Guided feedback Staff was engaged in making hospitalwide change
House-wide Implementation Presented at shared governance Every clinical nurse Formal packets Tear-out review form
House-wide Implementation 30 min conversations During shift Before/after work Return form to leadership Uploaded in annual performance system
Ambulatory Nursing Process Clinical Ladder nurses Medical group Academic office sites Professional practice nurse leaders Provided education Created pairs
Outcomes Peer review conversations Strengthened unit Nurses felt empowered Nurses developed better working relationships Nurses could comfortably provide constructive feedback No more who said that about me Nurses own the feedback
Outcomes Impact on quality and safety Clinical nurses sharing best practices Holding peers to standards
Qualitative Outcomes What have I already done.. Focused on fall huddles and hourly patient rounds, completed Central line audits and practiced fiscal responsibility Currently involved in the practice council after only 1 year on the unit, excellent work! Worked on the Rothman Index as a unit champion
Qualitative Outcomes What could I do better.. Would like to see more participate in the council work or implementing a new process on the unit Could work on fiscal responsibility and decrease waste with bedside supplies Jocelyn recognized she could improve her head to toe skin assessments to reduce pressure ulcers
Qualitative Outcomes How can I impact the quality domain Becoming a Clinical Ladder III and driving practice Sarah would be a great charge nurse, she has the knowledge and skills to help others Encourage peers to follow policies related to CHG baths and foley care
Pilot Quantitative Outcomes 70% 60% 50% 40% 30% 20% 10% 0% How would you rate your comfort level with receiving face to face peer feedback? Very comfortable Comfortable Neutral Slightly uncomfortable Very uncomfortable Number 10 31 8 2 0 Percent 19.61% 60.78% 15.69% 3.92% 0.00%
Pilot Quantitative Outcomes 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Do you feel you were appropriately paired with your assigned peer? Yes Number 45 8 Percent 88.24% 11.76% No
Lessons Learned Anticipate difficult conversations Provide early guidance Prepare for late-adopters Identify and support Plan for the when and where Unit workflow Uninterrupted conversations
Expanding domains Other roles Next Steps
References Nursing: Scope and Standard of Practice. (2010). American Nurses Association. Silver Spring, Maryland. p 24 Caring for Each Other: How to Speak Up and Give Peer Feedback. (2013). Penn State Hershey Milton S. Hershey Medical Center. P3-14. Code of Ethics or Nurses with Interpretative Statements. (2015) American Nurse Association, Silver Spring, Maryland. p 22.
Questions
Contact April Adley aadley@hmc.psu.edu Peter Andrews pandrews@hmc.psu.edu Judy Himes jhimes1@hmc.psu.edu Abigail Rudy arudy@hmc.psu.edu