Document Type

DNP Project


School of Nursing

Date of Degree

Spring 2021


Doctor of Nursing Practice (DNP)

Primary Advisor

Dr. Karen Kesten DNP, APRN, CCNS, CNE, CCRN-K, FAAN; Dr. Bonnie Sakallaris PhD, RN, NEA-BC


Nursing; Peer Review Program; Hospitals; Evidence-Based Nursing


Background and Purpose: The Institute of Medicine’s (IOM) landmark publication To Err Is Human: Building a Safer Healthcare System measured the impact of medical error on the American public in both unnecessary human suffering and unsustainable financial cost to the US healthcare system. Nursing literature suggests that peer review of safety events can help mitigate the impact of medical errors by increasing nurse accountability for practice and empowerment for leading change.

Methods: Fourteen volunteers were selected from over 900 direct care nurses to participate in a four-month Nursing Peer Review Program (NPRP) pilot. Structure, process, and outcome measures of implementation, pre-post measurement of participants’ perception of accountability and post-measurement of feelings of empowerment to lead change were evaluated.

Results: Structure, process, and outcome benchmarks were met with the exceptions of monthly meeting participation and survey completion goals. Overall accountability scores showed only slight improvement pre-versus post-implementation (pre [M=6.41, SD=0.30], (post [M=6.51; SD=0.23]). Participants reported a high overall mean empowerment score of 4.57 (SD=0.58). Several nursing policy changes and safety improvements were recommended following peer review activities during the pilot period.

Conclusions and Implications: An evidenced-based nurse-led peer review program supports direct care nurses to critically evaluate their practice and feel empowered to mediate deviations from standards of care that may result in patient harm. Based on NPRP pilot outcomes, this program shows benefit for improving patient outcomes and avoiding nurse related safety events as a result of direct care nurse quality improvement recommendations following peer review of their professional practice.

Open Access


Included in

Nursing Commons



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