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Impact of Nurse Peer Review on a Culture of Safety

Herrington, Cynthia R., DNP, RN, OCN, NE-BC; Hand, Mikel W., EdD, RN, OCN, NE-BC, NEA-BC

doi: 10.1097/NCQ.0000000000000361

Background: Nursing peer review (NPR) is essential in evaluating nursing practice. A common theme throughout the literature is that NPR holds nurses accountable for their practice.

Problem: The nursing profession has struggled to conduct peer review consistently due to lack of a standardized framework.

Approach: A NPR program was developed, implemented, and evaluated in a 355-bed acute care hospital in the Midwestern United States.

Outcomes: A pre- and postdesign using the Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture was used for evaluation. Paired t test results revealed statistically significant differences in group means for 2 questions: mistakes have led to positive changes here (P < .001, d = 1.31), and staff will freely speak up (P = .002, d = 0.67). Clinically significant differences in group means were noted for the remaining survey items.

Conclusions: Implementation of an NPR program is a promising means to improve the culture of safety in health care institutions.

Administration, Indiana University Health Bloomington Hospital (Dr Herrington); and Department of Graduate Nursing, College of Nursing and Health Professions, University of Southern Indiana, Evansville (Dr Hand).

Correspondence: Cynthia R. Herrington, DNP, RN, OCN, NE-BC, Administration, Indiana University Health Bloomington Hospital, 601 West Second St, Bloomington, IN 47403 (

The authors acknowledge Ms Brandi Smeltzer, MSEd, for her valuable editorial support for the project.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (

Accepted for publication: July 16, 2018

Published ahead of print: September 6, 2018

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