Elevating Care Through Nursing Peer Review

While physician peer review is a mandatory process that occurs in all U.S. hospitals, the nursing peer review process is not and, accordingly, is much less widespread. Its intent mirrors that of physician peer review—to ensure that well recognized standards of care are met and to apply lessons learned to improve patient care quality and safety.

Meaningful nursing peer review can enhance patient safety, improve quality of care, and support a culture of continuous learning. The American Nurses Credentialing Center (ANCC) has identified numerous standards consistent with the highest quality of nursing care and healthcare organizational structure. According to the ANCC, “The peer review process stimulates professionalism through increased accountability and promotes self-regulation of the practice.” 

Despite the potential benefits, nursing peer review is not required or standardized, which could be a missed learning opportunity. Nurses play a crucial role in the delivery of care, and their actions or inactions can trigger allegations of medical error or negligent care. 

Nursing-Related Claims Data

A Coverys analysis of 6,851 claims that closed between 2020 and 2024 identified 1,146 events in which nurses were directly involved in care that resulted in the alleged medical error. Nursing-related events accounted for 17% of closed events and 20% of indemnity paid during this time period.

Top locations for nursing-related events include:

• 71% - Patient Care Unit (patient room in acute care, long term care, critical care, and rehabilitation facilities)
• 13% - Surgical Suite (surgery, PACU)
• 12% - Labor & Delivery

Top risk management issues identified include:

• 43% - Clinical Decision-Making (patient monitoring, failure to rescue, fall prevention)
• 10% - Human Factors (cohesive team/handoffs, distractions, alarm fatigue)
• 9% - Medication-Related (medication administration, adverse reaction, medication reconciliation) 

This data provides valuable signals that lend insight into existing vulnerabilities and guide organizations in implementing proactive risk and quality improvement strategies. 

Risk Recommendations

Nursing peer review can be a powerful quality improvement and patient safety tool when it is implemented using a nonpunitive, standardized, and objective approach. The peer review structure allows nursing errors and adverse events to become learning opportunities to improve and enhance patient safety. Consider the following when implementing your organization’s nursing peer review program: 

• Do your homework. Research the nursing peer review process and the ways it can benefit your organization. Seek nursing peer review policies and procedures from reputable sources. Assess multiple nursing peer review programs/models at other facilities and utilize the practices that will work best at your own organization. Share your key learnings with the governing body, leadership, and other thought leaders in your organization. 
• Assess organizational capacity. Like physician peer review programs, nursing peer review programs require an investment of financial and human resources. The nursing peer review program must be staffed by adequate numbers of highly trained and/or experienced employees and peer review committee members. The cost of acquiring, creating, and maintaining documents related to the nursing peer review processes should be factored into the program budget. Work with an interdisciplinary team to determine whether your organization has the resources, capacity, and ability to build and support a nursing peer review program. 
• Know the law. Consult an attorney to understand the legal protections your state affords to nursing peer review and how to optimize them. Work with your attorney to ensure the proper design and implementation of a nursing peer review program and process that complies with state and federal law. Confirm that all documents related to the peer review process contain sufficient language to maximize the protections afforded under relevant state law.
• Map a process. Plan the implementation of a nursing peer review process that:
  • Provides guidelines for case submittal.
  • Identifies triggers for peer review and appropriate reviewers.
  • Creates a charter to document the intent and actions of the clinical peer review committee.
  • Selects a committed and diverse clinical peer review committee membership.
  • Maintains accurate records and designates where to keep them.
  • Maintains confidentiality of all process phases and documentation.
  • Creates a written nursing peer review policy and procedure.
• Implement the plan. After the plan is finalized and approved, implement the nursing peer review program as planned. Encourage staff buy-in by educating them about the purpose, value, and process of nursing peer review. Ensure that all involved nursing staff are aware of their respective roles and responsibilities. Notify all involved staff of the program’s start date.
• Evaluate regularly. Identify quantifiable measures to track program progress/success. Share data and responsive actions with the appropriate quality improvement and/or patient safety committee to facilitate process improvement. Regularly review and evaluate the program and make improvements, as necessary.

Standardized nursing peer review processes can increase organizational systematic learning while reducing nursing errors and their impact on patients and their families. When an adverse nursing event occurs, a peer review process can uncover opportunities for improvement and help prevent repeat occurrences.