Peer Review in a Union Environment

Jody Charles, MSN, RNCathy Patton, MA, RNChris Tarver, MS, RN, CNSJanuary 10, 2013

History of Peer Review

PRN – union over 30 years

Just for RNs, just at ECH

1st Designation Submittal 2005:• Absolute refusal of union to discuss• Documentation submitted included

communication between CNO and President regarding Peer Review

• Surveyors met privately with the union during site visit

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History (cont).

2nd Designation Submittal 2009:

• On advice of ANCC Consultant, looked at Peer Review in form of direct care nurse feedback

• Submitted in documentation competency check offs and various audits done by direct care nurses on other direct care nurse’s practice

• A bit of a stretch

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In prep for 3rd Submittal 2014

Our CNO, Diana Russell, wanted to elevate peer review

Presentation by CNO to Union Board• Research on benefits presented• Explanation of peer review in a union setting

• Union strong stance regarding education of all RNs who were going to be asked to give feedback

Agreement reached . . . When leadership committed to educational plan with union input

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Where to Begin?

• Magnet requirement:

• “Peer Review at all levels”

• The beginning work is focused

on the Direct Care Nurses

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Start up . . .

Selection Committee Leadership

Manager from each campus asked by the CNO

Nursing Education Manager “Consultant/Facilitator”

Selecting of the Peer Review model/resource

We had relationship with Barb Haag-Heitman

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Recruiting• Feb 2011: CNO presented to CPC the agreement

with PRN and what Peer Review entails

• Recruiting of direct care nurses• “All RN” flier/email & “In Touch” Message• Message to: Call Nursing Ed Manager for

details

• Presentation to

managers at

Nursing Leader Council

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First meeting of committee

• Sept 2011 1st meeting• Clinical Ladder process comparison to peer

review (exemplars) – gave the DCN a point of reference from past practice

• Distribution of book: Peer Review in Nursing• Given task to read the book

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2nd Meeting of Group

• Oct 2011 2nd Meeting• Discussion of pilot unit criteria • Discussion of policies and procedures

• Very important to CNO and union that the nurses developed their process so that they could promote it

• Direct Care Nurses able to say what they wanted and didn’t want in a process

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3rd Meeting – November 2011

• Barb Haag-Heitman brought in to meet with committee members in full-day session

• Agenda included: • Developed vision and goals• DESC Model • Selected Direct Care Nurse co-chairs

• went around room, and offers made to lead; vote taken

• Met with managers at conclusion

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ECH Peer Review Committee Vision

“Leading the nursing community in promoting the highest standards of patient care through the peer review processes.”

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ECH Peer Review Committee Goals

1. Create sustainable peer review process to promote professional nursing practice at ECH.

2. Increase individual and group accountability for positive patient outcomes.

3. Foster a healthy work environment.

4. Create supportive learning relationships.

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DESC Model (B. Haag-Heitman)

• Describe

• Express

• Suggest

• (Positive) Consequences

Examples . . .

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Development of Process Details

• Very important to nurses to have peer review not be included in performance appraisal process

• Selected pilot unit at each campus

• Everyone would be expected to participate

• Change in DCN leadership in Feb 2012• one-on-one conversation with manager

facilitator and DCN leader• replaced with DCN leader who was former CPC

chair

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Spring 2012

• Several meetings on education for Committee about DESC model:• Allowed members to get feedback from

colleagues on the model

• Education plan discussed and developed

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Summer 2012• Meeting with CNO to review implementation plan in

order for CNO to present to union

• Quarterly plan of a focused competency per quarter• based on nursing strategic plan

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Each Quarterly Cycle

• Early in First month of quarter: competency distributed

• 1st - 2nd month of quarter: complete peer review and turn competency into unit champion; review UPC

• 3rd month of quarter: bring to CPC

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Accepted Education Plan

• Barb Haag-Heitman returned

• Mandatory for pilot units; open to all DCN

• 2 hour classes; both campuses

• Manager of Nursing Education taught four make up sessions

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Unit Binders

• DCN leaders wanted to create this Resource for each unit, includes:• Articles on Peer Review• Competency Tools• Barb Haag-Heitman’s Powerpoint• Vision and Goals of Committee

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First Project

• Med Admin Competency• Related to our Bar Coding Medication

Administration initiative• HCAHPS data on med communication

• Barb Haag-Hietman suggested must have pre and post data to show that peer review made a difference

• Coached us on creating competency with strong focus

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Lessons Learned

• Selection of Pilot Unit:• data difficult to obtain for first project selected

for pilot units

• Need to assess: Does unit have another major project happening?

• Back up plan for nurses unable to attend mandatory training

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Questions?

Jody Charles

Jody.Charles@elcaminohospital.org

THANK YOU!!

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