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Collaborative Rural Nurse Peer Review

A Quality Improvement Project

Drobny, Stephanie D. MS-HSL, RN; Snell, Amy RNC-OB, BSN; Morris, Lisa MSN-ED, RN-BC, CEN; Harshbarger, Cathy MHA, BSN, RN; Village, Pat MS, RN; Fischer, Shelly A. PhD, RN

doi: 10.1097/NCQ.0000000000000331

Background: Peer review is an essential element of professional nursing practice.

Local Problem: Implementing nursing practice peer review is a challenge in any organization; some characteristics of small and rural hospitals can make the task especially daunting.

Methods: A team of nursing leaders and staff nurses from rural and critical access hospitals within 1 health care system was formed to make recommendations about implementing nursing practice peer review in the small rural facilities. Barriers included limited numbers of nurse reviewers by nursing specialty and inherent bias of reviewers due to personal knowledge of cases and nurses involved.

Interventions: A collaborative rural nursing practice peer review council was created, with staff nurse and leader representation from 6 geographically distinct facilities.

Results: The rural collaborative council has developed processes for case referral, reviewer assignment, investigation, and scoring founded on Just Culture principles. Satisfaction among staff nurses, reviewers, and Chief Nursing Officers has been high.

Conclusions: Barriers to implementation of nursing practice peer review in rural hospitals can be mitigated through a collaborative approach, resulting in efficient and effective processes for small, rural, and geographically distinct hospitals.

Banner Fort Collins, Colorado (Ms Drobny); Page Hospital, Page, Arizona (Ms Snell); Fay W. Whitney School of Nursing, University of Wyoming, Laramie (Dr Fischer); Sanford Health, Fargo, North Dakota (Ms Morris); Banner Lassen, Susanville, California (Ms Harshbarger); and Banner Health, Loveland, Colorado (Ms Village).

Correspondence: Shelly A. Fischer, PhD, RN, Fay W. Whitney School of Nursing, University of Wyoming, 1000 E. University Ave, Laramie, WY 82071 (

Our team thanks Carla Wade, MSN/MBA-HCM, RN, for her visionary leadership and support for this project.

The authors declare no conflicts of interest.

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

Accepted for publication: February 5, 2018

Published ahead of print: June 8, 2018

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